The available economic evidence base for ESTNBC is limited. This study evaluated costs and HCRU for patients receiving neoadjuvant treatment for ESTNBC.
This was a retrospective observational study of patients with ESTNBC from US community oncology practices. Patients were required to be adult females diagnosed with stage II-IIIB ESTNBC between 3/2008 and 3/2016 with definitive surgery following neoadjuvant systemic therapy, with or without adjuvant therapy. Cost and HCRU were evaluated descriptively from neoadjuvant treatment initiation until surgery (Time 1) and surgery until the earliest of first recurrence, death, or end of record (Time 2).
Of 308 eligible patients, 236 received neoadjuvant but not adjuvant treatment (Neo) and 72 received neoadjuvant and adjuvant treatment (Neo+Adj). Mean monthly cost for Neo was $14,466 for Time 1 with infused or injected supportive care (antiemetics, anti-neutropenia, anti-anemia) [ISC] ($5,305) and systemic anticancer therapy [SAT] ($4,464) respectively as primary cost drivers. Monthly cost was $12,989 for Neo+Adj, with ISC ($4,320) and SAT ($3,538) as the highest cost components. Time 2 mean monthly cost was $1,120 for Neo, with hospitalization [HOS] ($636) followed by ED visits ($214) as the key costs. For Neo+Adj, mean monthly cost was $3,167, with HOS ($1,851) and SAT ($513) as key cost drivers for Time 2. HCRU was highest in Time 1 for Neo and Neo+Adj. The table reports HCRU by category for Time 1 and 2.
TableMean number of events per month per incident patient, Mean (SD)
|Time 1||Time 2|
|Neo (N=236)||Neo+Adj (N=72)||Neo (N=236)||Neo+Adj (N=72)|
|Hospitalization||0.25 (0.098)||0.31 (0.234)||0.06 (0.098)||0.12 (0.127)|
|ED Visits||0.24 (0.124)||0.30 (0.078)||0.06 (0.055)||0.07 (0.086)|
|Infused or Injected Supportive Care||1.49 (1.328)||2.18 (1.924)||0.02 (0.007)||0.37 (0.438)|
|Office Visit||2.41 (1.359)||2.96 (1.221)||0.29 (0.328)||0.58 (0.788)|
The results of the present study demonstrate the economic and resource burden of ESTNBC, particularly during the time from neoadjuvant treatment initiation until surgery.
Legal entity responsible for the study
Merck Sharp & Dohme Corp.
Merck Sharp & Dohme Corp.
W.C. Rhodes: Full/Part-time employment: Concerto HealthAI; Research grant/Funding (institution): Merck. S. Gautam: Full/Part-time employment: Concerto HealthAI; Research grant/Funding (institution): Merck. A. Haiderali: Shareholder/Stockholder/Stock options, Full/Part-time employment: Merck. M. Huang: Full/Part-time employment: Merck. J. Sieluk: Full/Part-time employment: Merck. K.E. Skinner: Full/Part-time employment, Employee of Concerto HealthAI during the conduct of this research. Current employer is St. Jude Children's Research Hospital: Concerto HealthAI; Research grant/Funding (institution): Merck. L.S. Schwartzberg: Full/Part-time employment: West Cancer Center; Advisory/Consultancy: Merck; Advisory/Consultancy, Research grant/Funding (institution): Pfizer; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Genentech; Advisory/Consultancy: Spectrum Pharmaceuticals; Speaker Bureau/Expert testimony: Puma Biotechnology; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Amgen.
© 2020 The Authors. Published by Elsevier Inc. All rights reserved.