title: Identification and cost of adverse events in metastatic breast cancer in taxane and capecitabine based regimens.
abstract: OBJECTIVE
  We sought to compare the economic impact of treatment-related adverse events (AEs) in patients with metastatic breast cancer (mBC) using taxane- or capecitabine-based treatment regimens as either first- or second-line (FL or SL) therapy in the US.
  
  
  METHODS
  We used healthcare claims data from the Truven Health Analytics MarketScan® Commercial Databases to conduct a retrospective cohort study comparing the economic impact of AEs amongst taxane- and capecitabine-treated mBC patients in the US. We selected women diagnosed with mBC between 2008-2010 who received a taxane or capecitabine as first- or second-line (FL or SL) chemotherapy. Costs related to hospitalization, outpatient services, emergency department visits, chemotherapy and other medications were tabulated and combined to determine total healthcare costs. The incremental monthly costs associated with the presence of AEs compared to no AEs were estimated using generalized linear models, controlling for age and Charlson Comorbidity Index.
  
  
  RESULTS
  We identified 15,443 mBC patients meeting inclusion criteria. Adjusted total monthly costs were significantly higher in those who experienced AEs than in those without AEs in both lines of treatment (FL incremental cost: taxanes $1,142, capecitabine $1,817; SL incremental cost: taxanes $1,448, capecitabine $4,437). Total costs increased with the number of AEs and were primarily driven by increased hospitalization amongst those with AEs.
  
  
  CONCLUSIONS
  Adverse events in taxane- or capecitabine-treated mBC patients are associated with significant increases in costs. Selecting treatment options associated with fewer AEs may reduce costs and improve outcomes in these patients.
authors.affiliation: University of Washington, Seattle, WA USA ; Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, 1959 NE Pacific Ave, H-375Q, Box 357630, Seattle, WA 98195-7630 USA.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
authors.affiliation: University of Washington, Seattle, WA USA ; Fred Hutchinson Cancer Research Center, Seattle, WA USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.affiliation: Genentech Inc, South San Francisco, CA USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Lalla
authors.affiliation: Genentech Inc, South San Francisco, CA USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Masaquel
authors.affiliation: Genentech Inc, South San Francisco, CA USA.
authors.forename: Tripthi
authors.initials: T
authors.lastname: Kamath
authors.affiliation: Genentech Inc, South San Francisco, CA USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Brammer
authors.affiliation: UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, CA USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Hurvitz
authors.affiliation: University of Washington, Seattle, WA USA ; Fred Hutchinson Cancer Research Center, Seattle, WA USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
keywords: Adverse effects; Antineoplastic agents; Breast neoplasms; Costs and cost analysis