Patterns of resource utilization and cost for postmenopausal women with hormone-receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer in Europe.
BACKGROUND
Healthcare resource utilization in breast cancer varies by disease characteristics and treatment choices. However, lack of clarity in guidelines can result in varied interpretation and heterogeneous treatment management and costs. In Europe, the extent of this variability is unclear. Therefore, evaluation of chemotherapy use and costs versus hormone therapy across Europe is needed.


METHODS
This retrospective chart review (N = 355) examined primarily direct costs for chemotherapy versus hormone therapy in postmenopausal women with hormone-receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancer across 5 European countries (France, Germany, The Netherlands, Belgium, and Sweden).


RESULTS
Total direct costs across the first 3 treatment lines were approximately €10,000 to €14,000 lower for an additional line of hormone therapy-based treatment versus switching to chemotherapy-based treatment. Direct cost difference between chemotherapy-based and hormone therapy-based regimens was approximately €1900 to €2500 per month. Chemotherapy-based regimens were associated with increased resource utilization (managing side effects; concomitant targeted therapy use; and increased frequencies of hospitalizations, provider visits, and monitoring tests). The proportion of patients taking sick leave doubled after switching from hormone therapy to chemotherapy.


CONCLUSIONS
These results suggest chemotherapy is associated with increased direct costs and potentially with increased indirect costs (lower productivity of working patients) versus hormone therapy in HR+, HER2- advanced breast cancer.
Centre Hospitalier Universitaire Sart Tilman Liège and Liège University, Domaine Universitaire du Sart Tilman, B35, 4000, Liège, Belgium. g.jerusalem@chu.ulg.ac.be.
Guy
G
Jerusalem
University Hospitals Leuven, Herestraat 49, box 7003, B-3000, Leuven, Belgium. patrick.neven@uz.kuleuven.ac.be.
Patrick
P
Neven
Navigant Consulting, Inc, Woolgate Exchange, 25 Basinghall Street, EC2V 5HA, London, UK. Nina.Marinsek@navigant.com.
Nina
N
Marinsek
Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA. jie.zhang@novartis.com.
Jie
J
Zhang
Navigant Consulting, Inc, Woolgate Exchange, 25 Basinghall Street, EC2V 5HA, London, UK. ravi.degun@navigant.com.
Ravi
R
Degun
Novartis Farma S.p.A., Largo Umberto Boccioni 1, I-21040, Origgio, VA, Italy. giancarlo.benelli@novartis.com.
Giancarlo
G
Benelli
Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA. stephen.saletan@novartis.com.
Stephen
S
Saletan
Wellmera AG, Basel, Switzerland. jf.ricci@wellmera.com.
Jean-François
JF
Ricci
Institut Gustave Roussy, 39 Rue C. Desmoulins, 94805, Villejuif, France. fandre@igr.fr.
Fabrice
F
Andre
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D004311:Double-Blind Method; D015914:Estrogen Replacement Therapy / Q000191:economics / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017698:Postmenopause / Q000187:drug effects; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D064726:Triple Negative Breast Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy
D000970:Antineoplastic Agents