脑转移乳腺癌的负担：法国国家医院数据库分析。

Burden of breast cancer with brain metastasis: a French national hospital database analysis.

机构信息

Epidémiologie, Evaluation et Politiques de santé (EA 4069), Université Paris Descartes, Sorbonne Paris Cité, France.

出版信息

J Med Econ. 2012;15(3):493-9. doi: 10.3111/13696998.2012.662924. Epub 2012 Feb 17.

DOI:10.3111/13696998.2012.662924

PMID:22304337

Abstract

OBJECTIVE

Incidence of breast cancer with brain metastases (BCBM) is increasing, especially among patients over-expressing HER2. Epidemiology on this sub-type of cancer is scarce, since cancer registries carry no information on the HER2 status. A retrospective database analysis was conducted to estimate the burden of BCBM, especially among HER2-positive patients in a secondary objective.

METHODS

Patients with a new diagnosis of BCBM carried out between January and December 2008 were identified from the national hospital database using the International Disease Classification. Patients receiving a targeted anti-HER2 therapy were identified from the national pharmacy database. Hospital and pharmacy claims were linked to estimate the burden of HER2-positive patients. Data on hospitalizations were extracted to describe treatment patterns and healthcare costs during a 1-year follow-up. Predictors of treatment cost were analyzed through multi-linear regression analysis.

RESULTS

Two thousand and ninety-nine BCBM patients were identified (mean age (SD) = 57.8 (13.6)), of whom 12.2% received a targeted anti-HER2 therapy; 79% of patients had brain metastases associated with extracranial metastases, and the attrition rate reached 82%. Patients received mostly palliative care (47.4%), general medical care (40.6%), and chemotherapy (35.0%). The total annual hospital cost of treatment was 8,426,392€, representing a mean cost of 22,591€ (±14,726) per patient, mainly influenced by extracranial metastases, surgical acts, and HER2-overexpression (p < 0.0001).

CONCLUSIONS

The database linkage of hospital and pharmacy claims is a relevant approach to identify sub-type of cancer. Chemotherapy was widely used as a systemic treatment for breast cancer rather than for local treatment of brain metastases whose morbi-mortality remains high. The variability of treatment costs suggests clinical heterogeneity and, thus, extensive individualization of protocols.

摘要

目的

乳腺癌伴脑转移（BCBM）的发病率正在上升，尤其是在 HER2 过表达的患者中。由于癌症登记处不提供 HER2 状态的信息，因此针对这种癌症亚型的流行病学信息很少。本回顾性数据库分析旨在估计 BCBM 的负担，特别是在次要目标中针对 HER2 阳性患者的负担。

方法

使用国际疾病分类从国家医院数据库中确定 2008 年 1 月至 12 月期间新诊断为 BCBM 的患者。从国家药房数据库中确定接受靶向抗 HER2 治疗的患者。对医院和药房的索赔进行链接，以估计 HER2 阳性患者的负担。提取有关住院的数据，以描述 1 年随访期间的治疗模式和医疗保健费用。通过多元线性回归分析分析治疗费用的预测因素。

结果

确定了 2099 例 BCBM 患者（平均年龄（SD）=57.8（13.6）），其中 12.2%接受了靶向抗 HER2 治疗；79%的患者有脑转移伴颅外转移，流失率达到 82%。患者主要接受姑息治疗（47.4%）、一般医疗护理（40.6%）和化疗（35.0%）。治疗的总年度医院费用为 8426392 欧元，代表每位患者的平均费用为 22591 欧元（±14726），主要受颅外转移、手术行为和 HER2 过表达的影响（p<0.0001）。