US Medical Affairs, Genentech Inc., South San Francisco, CA, USA.
Medical Affairs, Noesis Healthcare Technologies Inc., Redwood City, CA, USA.
Adv Ther. 2020 Apr;37(4):1632-1645. doi: 10.1007/s12325-020-01283-4. Epub 2020 Mar 14.
INTRODUCTION: Claims data (IBM MarketScan Commercial and MarketScan Medicare Supplemental databases) from June 30, 2011 to September 30, 2017 were used to evaluate the cost impact of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) in this retrospective cohort study. METHODS: The primary analysis compared short-term costs for patients diagnosed with HER2+ MBC at least 180 days after the end of first HER2-targeted treatment (MBC+ cohort) versus a propensity score matched cohort of patients with breast cancer who did not develop MBC (MBC- cohort). A pseudo-post period for patients in the HER2+ MBC- cohort was defined by indexing to the HER2+ treatment completion-MBC diagnosis time interval of the matched pair in the HER2+ MBC+ cohort; we then compared average monthly cost differences between these groups for the year preceding and following MBC diagnosis. In secondary analyses, we estimated medium-term aggregate and categorical healthcare costs for patients with HER2+ MBC up to 3 years post-diagnosis. RESULTS: In the short-term primary analysis, costs for the HER2+ MBC+ and HER2+ MBC- cohorts were largely comparable in the year preceding MBC diagnosis. Monthly direct costs were significantly higher for the HER2+ MBC+ cohort in the months immediately preceding MBC diagnosis, with differences in the range of $500-5000. Following diagnosis, total monthly costs were $13,000-34,000 higher for patients in the HER2+ MBC+ cohort vs. the HER2+ MBC- cohort. In the medium-term secondary analysis, mean per patient total costs were $218,171 [standard error (SE) $5450] in the first year following MBC diagnosis and $412,903 (SE $13,034) cumulatively over 3 years following diagnosis (among patients with complete follow-up). Primary cost contributors were outpatient visits ($195,162; SE $8043) and HER2-targeted therapy drug costs ($177,489; SE $8120). CONCLUSIONS: HER2+ MBC is associated with high short-term and medium-term direct healthcare costs. These could be alleviated with early diagnosis and optimal standard-of-care treatment for early breast cancer, which can significantly reduce the risk of recurrence.
简介：本回顾性队列研究使用 2011 年 6 月 30 日至 2017 年 9 月 30 日的 IBM MarketScan 商业和 MarketScan 医疗保险补充数据库中的索赔数据，评估人表皮生长因子受体 2（HER2）阳性转移性乳腺癌（MBC）的成本影响。
方法：主要分析比较了至少在首次 HER2 靶向治疗结束后 180 天诊断出 HER2+MBC 的患者（MBC+组）与未发展为 MBC 的乳腺癌患者（MBC-组）的短期成本。MBC-组的患者定义了一个伪后周期，方法是将其与 MBC+组中匹配对的 HER2+治疗完成-MBC 诊断时间间隔索引化；然后，我们比较了这两组在 MBC 诊断前一年和后一年的平均每月成本差异。在次要分析中，我们估计了诊断后 3 年内 HER2+MBC 患者的中期总括和分类医疗保健成本。
结果：在短期主要分析中，在 MBC 诊断前一年，HER2+MBC+组和 HER2+MBC-组的成本基本相当。在 MBC 诊断前的几个月中，HER2+MBC+组的直接月度成本显著更高，差异在 500-5000 美元之间。诊断后，HER2+MBC+组患者的总月度费用比 HER2+MBC-组高 13000-34000 美元。在中期次要分析中，在 MBC 诊断后第一年，每位患者的平均总费用为 218171 美元（标准误差[SE]为 5450 美元），在诊断后 3 年内累计为 412903 美元（在有完整随访的患者中）。主要成本贡献者是门诊就诊（195162 美元；SE 为 8043 美元）和 HER2 靶向治疗药物费用（177489 美元；SE 为 8120 美元）。
结论：HER2+MBC 与高短期和中期直接医疗保健成本相关。通过早期诊断和早期乳腺癌的最佳标准护理治疗，可以减轻这些负担，这可以显著降低复发风险。
Breast Cancer (Dove Med Press). 2019-1-17
Am Health Drug Benefits. 2016-2
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