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

Abstract

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.

Fig. 1

Flow diagram showing the methodology for comparison of resource utilization in the three cohorts. Abbreviations: ABC, advanced breast cancer; HT, hormone therapy; TT, targeted therapy

Fig. 2

Direct overall costs by patient cohort. The costs in cohort A were significantly lower than the costs in cohort C (p < 0.001, Mann-Whitney U test). Average treatment durations by type and line of therapy in each cohort are shown in parentheses. Abbreviations: HT, hormone therapy; Tx, treatment; wk, week(s)

Fig. 3

Direct average monthly costs by patient cohort and line of treatment. Costs in cohort A 1st line (HT) were significantly lower compared with costs in cohort A 2nd line (chemotherapy) and cohort C (any therapy; p < 0.001 for both comparisons, Mann-Whitney U test). Abbreviation: HT, hormone therapy

Fig. 4

Overall use of concomitant targeted therapies and complementary treatments to manage chemotherapy side effects. Abbreviations: HT, hormone therapy; Rx, prescriptions; TT, targeted therapy. *Data presented for first line of chemotherapy treatment in each cohort

Fig. 5

Cohort A: hormone therapy versus chemotherapy regimens for (a) monitoring tests and (b) healthcare resource utilization. Cohort A received HT 1st line followed by chemotherapy 2nd line and any treatment 3rd line. Abbreviations: CT, computed tomography; GP, general practitioner; HT, hormone therapy; MRI, magnetic resonance imaging; PET, positron emission tomography; TT, targeted therapy