title: [Treatment patterns in advanced breast cancer with anthracycline and taxanes and their costs in three public hospitals of Mexico].
abstract: OBJECTIVE
  In Mexico, breast cancer is the second leading cause of cancer mortality among females. For patients with advanced breast cancer (ABC) resistant to anthracyclines and taxanes (AT), there are limited treatment options. There is a scarcity of data regarding clinical management of this population and treatment costs at this stage of the disease. The objective of this study was to describe the treatment patterns of care for metastatic breast cancer after AT and the associated cost from the point-of-view of the Mexican Public Health Care Sector.
  
  
  METHODS
  Between January 1, 2004 and December 31, 2007, a retrospective cohort of adult female ABC patients resistant to AT was developed by reviewing and extracting key data from medical charts. We conducted a retrospective, transversal and descriptive analysis of the patient data. Target population data files were obtained from 414 patients from 3 public hospitals in México.
  
  
  RESULTS
  Capecitabine, vinorelbine and cyclophosphamide were the most commonly prescribed agents, however clinical drug therapy management of the disease was different within and among the three hospitals included in the study. This difference translated into a disparity of prescription costs, ranging from an average of $122.22 pesos/patient/month (cyclophosphamide, IC 95% $94.43-$150.01) to $37,835.53 pesos/patient/month (capecitabine+trastuzumab IC 95% $34,953.18-$40,717.88) for the first treatment after AT.
  
  
  CONCLUSIONS
  The results highlight a lack of standardized care for patients and suggest that differences in treatment patterns are not only a reflection of scarcity of scientific data and diversity of prescription preferences among physicians but also of economic restrictions. Ultimately, there is a clear unmet medical need to be addressed through evidence-based medicine alternatives that support efficacy and cost effectiveness treatments.
authors.affiliation: Hospital de Oncología Siglo XXI del IMSS, México D.F., México.
authors.forename: Juan Alejandro
authors.initials: JA
authors.lastname: Silva
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Gonzalez
authors.forename: Juan Enrique
authors.initials: JE
authors.lastname: Bargalló
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hernández-Rivera
authors.forename: Xóchitl
authors.initials: X
authors.lastname: Gómez-Roel
authors.forename: Sigfrido
authors.initials: S
authors.lastname: Rangel
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Vargas-Valencia
authors.forename: Jonathan
authors.initials: J
authors.lastname: Martínez-Fonseca
authors.forename: Bonnie Meyer Korenblat
authors.initials: BM
authors.lastname: Donato
authors.forename: Ariadna
authors.initials: A
authors.lastname: Juárez-García
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage / Q000191:economics; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics; D019008:Drug Resistance, Neoplasm; D019317:Evidence-Based Medicine; D005260:Female; D054625:Healthcare Disparities / Q000191:economics; D017721:Hospital Costs; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D008800:Mexico; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics*; D017150:Public Sector / Q000191:economics; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000191:economics*; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics; D017211:Treatment Failure
chemical_list: D018943:Anthracyclines; D043823:Taxoids