title: [Impact of the chemotherapy protocols for metastatic breast cancer on the treatment cost and the survival time of 371 patients treated in three hospitals of the Rhone-Alpes region].
abstract: The chemotherapy of the metastatic breast cancer is characterized by the diversity of the treatment protocols and the utilisation of new expensive molecules posing the double problem of outcomes for the patients and financial effects for the hospitals. This survey describes the different chemotherapy treatments prescribed in the metastatic breast cancer and the direct costs supported by the hospitals according to the patient survival time. A cohort of 371 patients treated for a metastatic breast cancer was followed in three hospitals of the Rhone-Alpes region between 2001 and 2006. The detail of their different antineoplasic treatments, as well as the purchase cost of the drugs and their cost of hospital administration, the cost of the other hospital stays are presented in relation with the survival. The median survival time (35,8 months; CI 95%: [31.7-39.1]) since the first metastasis does not differ significantly according to the hospital. Ninety-three different chemotherapy protocols are observed combining from one to five molecules. Thirty-two different molecules are identified. In first line treatment, there is a significant difference in the use of the new molecules according to hospital (Chi(2) test; P < 10(-3)). The average cost of a chemotherapy treatment is 3,919 euro (+/- 8,069 euro), the higher cost is observed for trastuzumab (23,443 euro). The average time period before the beginning of a new chemotherapy line is 212 days (+/- 237 days) and the mean cost of hospital stay during this period is 3,903 euro (+/- 4,097 euro). If no impact of the chemotherapy treatment strategy is observed on the survival time of the patient, it is the opposite for the hospital treatment cost. These results are asking for a better control system of the authorization procedure of new molecules marketing and the harmonization of the practices.
authors.affiliation: Université de Saint-Etienne, CHU de Saint-Etienne, Hôpital Nord, SSPIM, Bâtiment CIM 42, Chemin de la Marandière, 42270 Saint-Etienne, France. trombert@univ-st-etienne.fr
authors.forename: B Trombert
authors.initials: BT
authors.lastname: Paviot
authors.forename: T
authors.initials: T
authors.lastname: Bachelot
authors.forename: G
authors.initials: G
authors.lastname: Clavreul
authors.forename: J-P
authors.initials: JP
authors.lastname: Jacquin
authors.forename: D
authors.initials: D
authors.lastname: Mille
authors.forename: J-M
authors.initials: JM
authors.lastname: Rodrigues
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D002173:Cancer Care Facilities / Q000191:economics; D016009:Chi-Square Distribution; D004180:Direct Service Costs; D016527:Drug Costs; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D016019:Survival Analysis
chemical_list: D018931:Antineoplastic Agents, Hormonal