A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer

Abstract

Purpose We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC). Methods We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I–III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. Results Overall, 4535 patients with stage I–III and 354 with stage IV HER2+ BC were identified. Most patients with stage I–III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I–III HER2+ BC. Conclusion Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC.

Neoadjuvant chemotherapy for triple-negative and Her2 +ve breast cancer: striving for the standard of care

“…Within a similar cohort to ours, Brezden-Masley et al identi ed NAC rates of 20.1% and 18.7% between 2012 and 2016 for patients with HER2 and TN breast cancers, respectively [14,15]. In 2015, the CREATE X trial was presented at the San Antonio breast cancer conference.…”

“…The use of NAC in the management of breast cancer has been examined in previous retrospective work using population-based and multi-institutional data [14][15][16][17][18][19]. These studies demonstrate variability in the rates of NAC based on geographic jurisdiction, breast cancer type and tumor characteristics.…”

“…As such, early referral to medical oncology is an essential component of multimodality treatment planning [10]. Despite these recommendations, we suspected there was a low use of NAC for patients with TN and HER2 breast cancers based on previous work in Canada and other countries, but that the overall rates of NAC use may be increasing over time given the newer evidence for post-NAC adjuvant therapies [14][15][16][17][18][19]. While rates of NAC use have been reported in various jurisdictions, factors affecting NAC use in TN and HER2 cancers has not been explored.…”

Long-term Survival Among Patients With De Novo Human Epidermal Growth Receptor 2–Positive Metastatic Breast Cancer in Manitoba

“…A Canadian study demonstrated that the annual per-patient costs of HER2-directed therapy (including drug cost and health care utilization) are three times higher in the MBC setting than in the early-stage setting. 28 Another study showed a substantial increase in health care costs since the approval of pertuzumab for HER2-positive MBC, 29 showing that despite the impressive OS benefit, pertuzumab is not cost-effective, which is of particular concern in the Canadian single-payer publicly funded health care system. 29 These studies further emphasize the need to identify which patients can safely discontinue HER2-directed therapy.…”

“…There is a need to identify which patients can safely discontinue HER2-directed therapy, as there is significant financial toxicity and quality of life implications with continuous treatment. A Canadian study demonstrated that the annual per-patient costs of HER2-directed therapy (including drug cost and health care utilization) are three times higher in the MBC setting than in the early-stage setting 28 . Another study showed a substantial increase in health care costs since the approval of pertuzumab for HER2-positive MBC, 29 showing that despite the impressive OS benefit, pertuzumab is not cost-effective, which is of particular concern in the Canadian single-payer publicly funded health care system 29 .…”