Biskupiak Joseph, Unni Sudhir, Telford Claire, Yoo Minkyoung, Ye Xiangyang, Deka Rishi, Brixner Diana, Stenehjem David
Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, USA.
Daiichi-Sanyko Inc, Baskin Ridge, New Jersey, Utah, USA.
BMC Health Serv Res. 2021 Jan 13;21(1):58. doi: 10.1186/s12913-020-06038-z.
Breast cancer costs were estimated at $16.5 billion in 2010 and were higher than other cancer costs. There are limited studies on breast cancer charges and costs by BRCA mutations and receptor status. We examined overall health care and breast cancer-related charges by BRCA status (BRCAm vs. BRCAwt), receptor status (HER2+ vs. HER2-), and treatment setting (neoadjuvant vs. adjuvant).
Retrospective cohort study of charge data from 1995-2014 in an academic medical center. Facilities, physician, pharmacy, and diagnosis-related charges were presented as mean and median charges with standard deviation (SD) and interquartile ranges (25%-75%). Wilcoxon rank-sum test was used to assess statistically significant differences in charges between comparators.
Total median breast-cancer related charges were $65,414 for BRCAm and $54,635 for BRCAwt (p=0.19); however all-cause charges were higher for BRCAm patients ($145,066 vs. $119,119, p<0.001). HER2+ status was associated with higher median breast cancer charges ($152,159 vs. $44,087, p<0.0001) that was driven by the charges for biological agents. Patients initially seen in the neoadjuvant setting had higher mean breast cancer charges than in the adjuvant setting ($117,922 vs. $80,061, p<0.0001).
BRCA mutation status was not associated with higher breast cancer charges but HER2+ status had significantly higher charges, due to charges for biological agents. Patients who initially received neoadjuvant treatment had significantly higher overall treatment charges than adjuvant therapy patients. With the advent of novel therapies for BRCAm, the economic impact of these treatments will be important to consider relative to their survival benefits.
2010年乳腺癌的花费估计为165亿美元，高于其他癌症的花费。关于BRCA突变和受体状态对乳腺癌费用及支出的研究有限。我们研究了按BRCA状态（BRCAm与BRCAwt）、受体状态（HER2+与HER2-）以及治疗阶段（新辅助治疗与辅助治疗）划分的总体医疗保健和乳腺癌相关支出。
对某学术医疗中心1995 - 2014年的费用数据进行回顾性队列研究。设施、医生、药房及诊断相关费用以均值、中位数费用以及标准差（SD）和四分位数间距（25% - 75%）表示。采用Wilcoxon秩和检验评估比较组间费用的统计学显著差异。
BRCAm患者的乳腺癌相关总中位数费用为65,414美元，BRCAwt患者为54,635美元（p = 0.19）；然而，BRCAm患者的全因费用更高（145,066美元对119,119美元，p < 0.001）。HER2+状态与更高的乳腺癌中位数费用相关（152,159美元对44,087美元，p < 0.0001），这是由生物制剂费用所致。最初接受新辅助治疗的患者的平均乳腺癌费用高于辅助治疗患者（117,922美元对80,061美元，p < 0.0001）。
BRCA突变状态与更高的乳腺癌费用无关，但HER2+状态因生物制剂费用而具有显著更高的费用。最初接受新辅助治疗的患者的总体治疗费用显著高于辅助治疗患者。随着针对BRCAm的新型疗法的出现，相对于其生存益处，考虑这些治疗的经济影响将很重要。
