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. 2020 Jun;181(3):653-665.
doi: 10.1007/s10549-020-05654-x. Epub 2020 Apr 28.

Medical costs associated with metastatic breast cancer in younger, midlife, and older women

Justin G Trogdon  1   2   3 , Christopher D Baggett  4   5 , Anagha Gogate  6 , Katherine E Reeder-Hayes  4   7 , Jason Rotter  6 , Xi Zhou  4 , Donatus U Ekwueme  8 , Temeika L Fairley  8 , Stephanie B Wheeler  6   4   9
Affiliations

Medical costs associated with metastatic breast cancer in younger, midlife, and older women

Justin G Trogdon et al. Breast Cancer Res Treat. 2020 Jun.

Abstract

Purpose: We estimated average medical costs due to metastatic breast cancer (mBC) among younger (aged 18-44), midlife (aged 45-64), and older women (aged 65 and older) by phase of care: initial, continuing, and terminal.

Methods: We used 2003-2014 North Carolina cancer registry data linked with administrative claims from public and private payers. We developed a claims-based algorithm to identify breast cancer patients who progressed to metastatic disease. We matched breast cancer patients (mBC and earlier stage) to non-cancer patients on age group, county of residence, and insurance plan. Outcomes were average monthly medical expenditures and expected medical expenditures by phase. We used regression to estimate excess costs attributed to mBC as the difference in mean payments between patients with mBC (N = 4806) and patients with each earlier-stage breast cancer (stage 1, stage 2, stage 3, and unknown stage; N = 21,772) and non-cancer controls (N = 109,631) by treatment phase and age group.

Results: Adjusted monthly costs for women with mBC were significantly higher than for women with earlier-stage breast cancer and non-cancer controls for all age groups and treatment phases except the initial treatment among women with stage 3 breast cancer at diagnosis. The largest expected total costs were for women aged 18-44 with mBC during the continuing phase ($209,961 95% Confidence Interval $165,736-254,186).

Conclusions: We found substantial excess costs for mBC among younger women and during the continuing and terminal phases of survivorship. It is important to assess whether this care is high value for these women.

Keywords: Breast cancer; Cost; Insurance; Metastatic; Young women.

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Conflict of interest statement

Conflicts of Interest: Dr. Trogdon worked with the Centers for Disease Control and Prevention under Intergovernmental Personnel Act 15IPA1504755. Drs. Wheeler and Reeder-Hayes received grant funding paid to their institution from Pfizer Foundation in the past 3 years. Ms. Gogate holds a pre-doctoral fellowship position with Bristol-Myers Squibb Company for work external to this study. All other authors report no conflict of interests.

Figures

Figure 1.
Figure 1.
CONSORT diagram used to illustrate select cancer cohort
Figure 2.
Figure 2.
Metastatic progression algorithm used to identify metastatic breast cancer disease
Figure 3a.
Figure 3a.
Total expected costs, by cancer stage, phase of care and age group: Age 18-44
Figure 3b.
Figure 3b.
Total expected costs, by cancer stage, phase of care and age group: Age 45-64
Figure 3c.
Figure 3c.
Total expected costs, by cancer stage, phase of care and age group: Age 65+
See this image and copyright information in PMC

References

    1. ACS. How Common is Breast Cancer? 2017.
    1. Johnson RH, Chien FL, Bleyer A. Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. JAMA - J Am Med Assoc. 2013. doi:10.1001/jama.2013.776 - DOI - PubMed
    1. Chollet-Hinton L, Anders CK, Tse CK, et al. Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer Study: A case-control study. Breast Cancer Res. 2016. doi:10.1186/s13058-016-0736-y - DOI - PMC - PubMed
    1. Anders CK, Johnson R, Litton J, Phillips M, Bleyer A. Breast Cancer Before Age 40 Years. Semin Oncol. 2009. doi:10.1053/j.seminoncol.2009.03.001 - DOI - PMC - PubMed
    1. Lee HB, Han W. Unique features of young age breast cancer and its management. J Breast Cancer. 2014. doi:10.4048/jbc.2014.17.4.301 - DOI - PMC - PubMed