Lang Kathleen, Huang Huan, Sasane Medha, Paly Victoria Federico, Hao Yanni, Menzin Joseph
Boston Health Economics, Inc, Waltham, MA, USA.
BMC Health Serv Res. 2014 Jul 9;14:298. doi: 10.1186/1472-6963-14-298.
BACKGROUND: Few studies have evaluated survival, treatment, resource use, and costs among women with stage IV ER + breast cancer (BC) who did not receive HER2 targeted therapy. METHODS: Using linked Surveillance, Epidemiology, and End Results (SEER) and Medicare data from 2006-2009, women aged 66+ years with an incident diagnosis of stage IV ER + BC (index date) in 2007 and no HER2 targeted therapy were identified. A comparison cohort without cancer was created from the SEER 5% Medicare sample and matched 1:1 to the study cohort based on age, sex, and race. All patients had continuous enrollment for a 12-month baseline period prior to index and were followed until the end of the study window, disenrollment, or death, whichever came first. Resource utilization and costs (by place of service, reported per patient per month, PPPM) were compared across cohorts. Treatment patterns including receipt of surgery, radiation, chemotherapy, aromatase inhibitors (AI), and non-AI hormonal therapy were evaluated for study cohort patients with at least 2 months of follow-up. Kaplan-Meier survival analysis was also conducted. RESULTS: 325 women with stage IV ER + BC without HER2 targeted therapy were identified and matched to 325 women without cancer. Mean age was 77 years for both cohorts, with average follow-up of 18 months for study patients and 26 months for comparison patients. Compared to the comparison cohort, study patients had significantly higher mortality (60.3% versus 31.1%, P < 0.001), shorter survival (survival at 36 months 28% vs. 62%) and higher resource utilization across all settings except for oral prescription drugs. Total PPPM healthcare costs were also significantly higher among study patients ($7,271 vs. $1,778, P < 0.001). Approximately 57% of study patients with 2+ months of follow-up received chemotherapy and over 62% received an AI during follow-up. Within 4 months of cancer diagnosis, surgery and radiation were received by 39% and 32% of study patients, respectively. CONCLUSIONS: We found significant excess clinical and economic burden among women with stage IV ER + breast cancer who did not receive HER2 targeted therapy. Future studies with more precise and recent data are warranted to confirm and extend these results.
背景：很少有研究评估未接受HER2靶向治疗的IV期雌激素受体阳性（ER+）乳腺癌（BC）女性的生存率、治疗情况、资源利用和成本。 方法：利用2006 - 2009年关联的监测、流行病学和最终结果（SEER）以及医疗保险数据，确定了2007年确诊为IV期ER+ BC（索引日期）且未接受HER2靶向治疗的66岁及以上女性。从SEER 5%医疗保险样本中创建了一个无癌症的对照队列，并根据年龄、性别和种族与研究队列进行1:1匹配。所有患者在索引日期前有连续12个月的基线期参保，并随访至研究窗口结束、退出研究或死亡，以先发生者为准。比较各队列的资源利用和成本（按服务地点，以每位患者每月报告，PPPM）。对随访至少2个月的研究队列患者评估治疗模式，包括手术、放疗、化疗、芳香化酶抑制剂（AI）和非AI激素治疗的接受情况。还进行了Kaplan-Meier生存分析。 结果：确定了325例未接受HER2靶向治疗的IV期ER+ BC女性，并与325例无癌症女性匹配。两个队列的平均年龄均为77岁，研究患者的平均随访时间为18个月，对照患者为26个月。与对照队列相比，研究患者的死亡率显著更高（60.3%对31.1%，P < 0.001），生存期更短（36个月时生存率28%对62%），除口服处方药外，在所有环境中的资源利用都更高。研究患者的总PPPM医疗费用也显著更高（7271美元对1778美元，P < 0.001）。在随访至少2个月的研究患者中，约57%接受了化疗，超过62%在随访期间接受了AI。在癌症诊断后的4个月内，分别有39%和32%的研究患者接受了手术和放疗。 结论：我们发现未接受HER2靶向治疗的IV期ER+乳腺癌女性存在显著过高的临床和经济负担。有必要开展更多使用更精确和最新数据的研究来证实和扩展这些结果。
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