title: Health resource utilization associated with skeletal-related events in patients with advanced breast cancer: results from a prospective, multinational observational study.
abstract: Patients with breast cancer and bone metastases often experience skeletal complications (skeletal-related events [SREs]: pathologic fracture, radiation to bone, surgery to bone or spinal cord compression). Prospective data on the health resource burden of SREs are needed for planning healthcare requirements and estimating the value of new treatments, but limited data are available. This prospective, observational study collected health resource utilization (HRU) data independently attributed to SREs by investigators. Eligible patients had bone metastases secondary to breast cancer, life expectancy ≥6 months, Eastern Cooperative Oncology Group (ECOG) performance status ≤2, and at least one SRE in the 97 days before enrollment. Data, collected retrospectively for 97 days before enrollment and prospectively for 18-21 months, included number and duration of inpatient stays, outpatient visits, emergency room visits and procedures. Altogether, 223 patients were enrolled from Germany, Italy, Spain and the UK. Of the 457 SREs, 118 (25.8%) were associated with inpatient stays. The mean duration of stay was 19.5 (standard deviation [SD] 19.2) days per SRE (based on 117 SREs). Surgery to bone and spinal cord compression were the SREs most likely to require inpatient stays (77.8% and 57.9% of SREs, respectively), while radiation to bone was the least likely (9.7%). Spinal cord compression required the longest inpatient stay per event (34.2 [SD 30.2] days) and radiation to bone the shortest (14.3 [SD 10.2] days). Overall, 342 SREs (74.8%) required an outpatient visit, with radiation to bone the most likely (85.7%), and surgery to bone the least likely (42.6%). Radiation to bone was also associated with the greatest number of outpatient visits per event (6.8 [SD 6.7] visits). All SREs were associated with substantial HRU therefore, preventing SREs in patients with breast cancer may reduce the burden imposed on healthcare systems.
authors.affiliation: Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Lüftner
authors.affiliation: National Cancer Institute IRCCS Giovanni Paolo II, Bari, Italy ; Oncology Institute ASL, Lecce, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Lorusso
authors.affiliation: Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Duran
authors.affiliation: Health Economics, Amgen (Europe) GmbH, Zug, Switzerland.
authors.forename: Guy
authors.initials: G
authors.lastname: Hechmati
authors.affiliation: Instituto Catalán d'Oncología ICO-IDIBELL, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Garzon-Rodriguez
authors.affiliation: Pinderfields General Hospital, Wakefield, UK.
authors.forename: John
authors.initials: J
authors.lastname: Ashcroft
authors.affiliation: University Hospitals Bristol, Bristol, UK.
authors.forename: Amit
authors.initials: A
authors.lastname: Bahl
authors.affiliation: Biostatistics, Ovatech Solutions, London, UK.
authors.forename: Prayashi
authors.initials: P
authors.lastname: Ghelani
authors.affiliation: Biostatistics, Amgen Inc, Thousand Oaks, CA USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wei
authors.affiliation: Scientific Publications, Amgen (Europe) GmbH, Zug, Switzerland.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas
authors.affiliation: Forschungszentrum Ruhr, Witten, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Hoefeler
keywords: Bone metastases; Breast cancer; Europe; Health resource utilization; Skeletal-related events