title: Costs associated with Eribulin treatment for patients with metastatic breast cancer in a comprehensive cancer center in France.
abstract: BACKGROUND
  There is no standard recommendation for metastatic breast cancer treatment (MBC) after two chemotherapy regimens. Eribulin (Halaven®) has shown a significant improvement in overall survival (OS) in this setting. Its use may however be hampered by its cost, which is up to three times the cost of other standard drugs. We report the clinical outcomes and health care costs of a large series of consecutive MBC patients treated with Eribulin.
  
  
  METHODS
  A monocentric retrospective study was conducted at Institut Curie over 1 year (August 2012 to August 2013). Data from patient's medical records were extracted to estimate treatment and outcome patterns, and direct medical costs until the end of treatment were measured. Factors affecting cost variability were identified by multiple linear regressions and factors linked to OS by a multivariate Cox model.
  
  
  RESULTS
  We included 87 MBC patients. The median OS was 10.7 months (95%CI = 8.0-13.3). By multivariate Cox analysis, independent factors of poor prognosis were an Eastern Cooperative Oncology Group (ECOG) performance status of 3, a number of metastatic sites ≥ 4 and the need for hospitalization. Per-patient costs during whole treatment were €18,694 [CI 95%: 16,028-21,360], and €2581 [CI 95%: 2226-3038] per month. Eribulin administration contributed to 79% of per-patient costs.
  
  
  CONCLUSIONS
  Innovative and expensive drugs often appear to be the main cost drivers in cancer treatment, particularly for MBC. There is an urgent need to assess clinical practice benefits.
authors.affiliation: General Practice Department, Faculty of Medicine, University of Reims Champagne-Ardenne, 51 Rue Cognacq-Jay, 51100 Reims, France. Electronic address: aline.hurtaud@wanadoo.fr.
authors.forename: Aline
authors.initials: A
authors.lastname: Hurtaud
authors.affiliation: Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France. Electronic address: anne.donnadieu@curie.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Donnadieu
authors.affiliation: Pharmacy, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France. Electronic address: laurence.escalup@curie.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Escalup
authors.affiliation: Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France. Electronic address: paul.cottu@curie.fr.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Cottu
authors.affiliation: Health Economics Unit, Institut Curie, 26 rue d'Ulm, 75005 Paris, France. Electronic address: sbaffert@fo-rothschild.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Baffert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D001932:Brain Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005602:France; D005663:Furans / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007659:Ketones / Q000191:economics* / Q000627:therapeutic use; D016014:Linear Models; D008113:Liver Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000556:secondary; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D015996:Survival Rate; D000095662:Polyether Polyketides
chemical_list: D000970:Antineoplastic Agents; D005663:Furans; D007659:Ketones; C490954:eribulin; D000095662:Polyether Polyketides
keywords: Breast cancer; Cost; Eribulin; Metastases