title: Comparison of medical costs and healthcare resource utilization of post-menopausal women with HR+/HER2- metastatic breast cancer receiving everolimus-based therapy or chemotherapy: a retrospective claims database analysis.
abstract: OBJECTIVE
  To analyze medical costs and healthcare resource utilization (HRU) associated with everolimus-based therapy or chemotherapy among post-menopausal women with hormone-receptor-positive, human-epidermal-growth-factor-receptor-2-negative (HR+/HER2-) metastatic breast cancer (mBC).
  
  
  METHODS
  Patients with HR+/HER2- mBC who discontinued a non-steroidal aromatase inhibitor and began a new line of treatment with everolimus-based therapy or chemotherapy (index therapy/index date) between July 20, 2012 and April 30, 2014 were identified from two large claims databases. All-cause, BC-related, and adverse event (AE)-related medical costs (in 2014 USD) and all-cause HRU per patient per month (PPPM) were analyzed for both treatment groups across patients' first four lines of therapies for mBC. Adjusted differences in costs and HRU between the everolimus and chemotherapy treatment group were estimated pooling all lines and using multivariable generalized linear models, accounting for difference in patient characteristics.
  
  
  RESULTS
  A total of 3298 patients were included: 902 everolimus-treated patients and 2636 chemotherapy-treated patients. Compared to chemotherapy, everolimus was associated with significantly lower all-cause (adjusted mean difference = $3455, p < 0.01) and BC-related ($2510, p < 0.01) total medical costs, with inpatient ($1344, p < 0.01) and outpatient costs ($1048, p < 0.01) as the main drivers for cost differences. Everolimus was also associated with significantly lower AE-related medical costs ($1730, p < 0.01), as well as significantly lower HRU (emergency room incidence rate ratio [IRR] = 0.83; inpatient IRR = 0.74; inpatient days IRR = 0.65; outpatient IRR = 0.71; BC-related outpatient IRR = 0.57; all p < 0.01).
  
  
  CONCLUSIONS
  This retrospective claims database analysis of commercially-insured patients with HR+/HER2- mBC in the US showed that everolimus was associated with substantial all-cause, BC-related, and AE-related medical cost savings and less utilization of healthcare resources relative to chemotherapy.
authors.affiliation: a a Analysis Group, Inc. , Boston , MA , USA.
authors.forename: Nanxin
authors.initials: N
authors.lastname: Li
authors.affiliation: b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
authors.forename: Yanni
authors.initials: Y
authors.lastname: Hao
authors.affiliation: a a Analysis Group, Inc. , Boston , MA , USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Koo
authors.affiliation: a a Analysis Group, Inc. , Boston , MA , USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Fang
authors.affiliation: a a Analysis Group, Inc. , Boston , MA , USA.
authors.forename: Miranda
authors.initials: M
authors.lastname: Peeples
authors.affiliation: a a Analysis Group, Inc. , Boston , MA , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kageleiry
authors.affiliation: a a Analysis Group, Inc. , Boston , MA , USA.
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.affiliation: c d Analysis Group, Inc. , Montreal , QC , Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Guérin
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000068338:Everolimus / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D009362:Neoplasm Metastasis; D018719:Erb-b2 Receptor Tyrosine Kinases; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D018719:Erb-b2 Receptor Tyrosine Kinases
keywords: Chemotherapy; Costs; Everolimus; HR+/HER2−; Healthcare resource utilization; Metastatic breast cancer