title: Treatment patterns, clinical outcomes and health care costs associated with HER2-positive breast cancer with central nervous system metastases: a French multicentre observational study.
abstract: BACKGROUND
  The population of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) who develop central nervous system (CNS) metastases is growing. Treatment strategies in this population are highly diverse. The objective of the study was to assess health care costs for the management of HER2 positive BC with CNS metastases.
  
  
  METHODS
  This multicentre, retrospective, observational study was conducted on HER2-positive BC patients diagnosed with CNS metastases between 2006 and 2008. Data were extracted from patient medical records to estimate health care resource use. A partitioned estimator was used to adjust censoring costs by use of the Kaplan-Meier survival estimate.
  
  
  RESULTS
  218 patients were included and costs were estimated for 200 patients. The median time to detection of CNS metastases was 37.6 months. The first metastatic event involved the CNS in 39 patients, and this was the unique first metastatic site in 31 of these patients. Two years following diagnosis of CNS metastases, 70.3% of patients had died. The mean per capita cost of HER2-positive BC with CNS metastases in the first year following diagnosis was €35,735 [95% CI: 31,716-39,898]. The proportion of costs attributed to expensive drugs and those arising from hospitalisation were in the same range.
  
  
  CONCLUSIONS
  A range of individualised disease management strategies are used in HER2-positive BC patients with CNS metastases and the treatments used in the first months following diagnosis are expensive. The understanding of cost drivers may help optimise healthcare expenditure and inform the development of appropriate prevention policies.
authors.affiliation: Department of Public Health, Health Economics unit, Institut Curie, 26 rue d'Ulm, Paris 75005, France. sandrine.baffert@curie.net.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Baffert
authors.forename: Paul
authors.initials: P
authors.lastname: Cottu
authors.forename: Youlia M
authors.initials: YM
authors.lastname: Kirova
authors.forename: Florence
authors.initials: F
authors.lastname: Mercier
authors.forename: Cécile
authors.initials: C
authors.lastname: Simondi
authors.forename: Thomas
authors.initials: T
authors.lastname: Bachelot
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.forename: Christelle
authors.initials: C
authors.lastname: Levy
authors.forename: Maya
authors.initials: M
authors.lastname: Gutierrez
authors.forename: Nicolas
authors.initials: N
authors.lastname: Madranges
authors.forename: Cristian
authors.initials: C
authors.lastname: Moldovan
authors.forename: Bruno
authors.initials: B
authors.lastname: Coudert
authors.forename: Dominique
authors.initials: D
authors.lastname: Spaëth
authors.forename: Daniel
authors.initials: D
authors.lastname: Serin
authors.forename: François-Emery
authors.initials: FE
authors.lastname: Cotté
authors.forename: Laure
authors.initials: L
authors.lastname: Benjamin
authors.forename: Cathie
authors.initials: C
authors.lastname: Maillard
authors.forename: Sabine
authors.initials: S
authors.lastname: Laulhere-Vigneau
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016543:Central Nervous System Neoplasms / Q000191:economics / Q000235:genetics / Q000401:mortality / Q000556:secondary*; D005260:Female; D005602:France / Q000453:epidemiology; D018734:Genes, erbB-2 / Q000235:genetics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult