title: Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality.
abstract: BACKGROUND
  The economic costs of treating patients with metastatic breast cancer have been examined in several studies, but available estimates of economic burden are at least a decade old. In this study, we characterize healthcare utilization and costs in the US among women with metastatic breast cancer receiving chemotherapy as their principal treatment modality.
  
  
  METHODS
  Using a large private health insurance claims database (2000-2006), we identified all women initiating chemotherapy for metastatic breast cancer with no evidence of receipt of concomitant or subsequent hormonal therapy, or receipt of trastuzumab at anytime. Healthcare utilization and costs (inpatient, outpatient, medication) were estimated on a cumulative basis from date of chemotherapy initiation ("index date") to date of disenrollment from the health plan or the end of the study period, whichever occurred first. Study measures were cumulated over time using the Kaplan-Meier Sample Average (KMSA) method; 95% CIs were generated using nonparametric bootstrapping. Findings also were examined among the subgroup of patients with uncensored data.
  
  
  RESULTS
  The study population consisted of 1444 women; mean (SD) age was 59.1 (12.1) years. Over a mean follow-up of 532 days (range: 3 to 2412), study subjects averaged 1.7 hospital admissions, 10.7 inpatient days, and 83.6 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $128,556 ($118,409, $137,644) per patient. Outpatient services accounted for 29% of total costs, followed by medication other than chemotherapy (26%), chemotherapy (25%), and inpatient care (20%).
  
  
  CONCLUSIONS
  Healthcare costs-especially in the outpatient setting--are substantial among women with metastatic breast cancer for whom treatment options other than chemotherapy are limited.
authors.affiliation: Policy Analysis Inc (PAI), Brookline, MA, USA.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Vera-Llonch
authors.forename: Derek
authors.initials: D
authors.lastname: Weycker
authors.forename: Andrew
authors.initials: A
authors.lastname: Glass
authors.forename: Sue
authors.initials: S
authors.lastname: Gao
authors.forename: Rohit
authors.initials: R
authors.lastname: Borker
authors.forename: Angie
authors.initials: A
authors.lastname: Qin
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009819:Office Visits / Q000191:economics; D011306:Prescription Fees / Q000706:statistics & numerical data; D011859:Radiography / Q000191:economics; D014481:United States
chemical_list: D000700:Analgesics; D000890:Anti-Infective Agents; D000932:Antiemetics