Costs of breast cancer recurrence after initial treatment for HR+, HER2−, high-risk early breast cancer: estimates from SEER-Medicare linked data

Abstract

Objective

To assess the costs of treated recurrence and survival in elderly patients with early breast cancer (EBC) at high risk of recurrence using Surveillance Epidemiology and End Results (SEER) registry-Medicare linked claims data.

Methods

This retrospective study included patients aged ≥65 years with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2−), node-positive EBC at high risk of recurrence. Treated recurrences were defined based on treatment events/procedure codes from claims. Primary outcomes were monthly total extra costs and cumulative extra costs of treated recurrence relative to patients with non/untreated recurrence. Costs were calculated using a Kaplan-Meier sampling average estimator method and inflated to 2021 US$. Secondary outcomes included analysis by recurrence type and overall survival (OS) after recurrence. Subgroup analysis evaluated costs in patients with Medicare Part D coverage.

Results

Among 3,081 eligible patients [mean (SD) age at diagnosis was 74.5 (7.1) years], the majority were females (97.4%) and white (87.8%). Treated recurrence was observed in 964 patients (31.3%). The monthly extra cost of treated recurrence was highest at the beginning of the first treated recurrence episode, with 6-year cumulative cost of $117,926. Six-year cumulative extra costs were higher for patients with distant recurrences ($168,656) than for patients with locoregional recurrences ($96,465). Median OS was 4.34 years for all treated recurrences, 1.92 years for distant recurrence, and 6.78 years for locoregional recurrence. Similar cumulative extra cost trends were observed in the subgroup with Part D coverage as in the overall population.

Limitations

This study utilizes claims data to identify treated recurrence. Due to age constraints of the dataset, results may not extrapolate to a younger population where EBC is commonly diagnosed.

Conclusion

EBC recurrence in this elderly population has substantial costs, particularly in patients with distant recurrences. Therapies that delay or prevent recurrence may reduce long-term costs significantly.

Keywords:

• Costs
• early breast cancer
• recurrence
• SEER-Medicare
• overall survival

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I00

Declaration of financial/other interests

ASV and AML are employees and stockholders of Eli Lilly and Company. PM, SZ, and AJ are employees of Medical Decision Modeling Inc. and performs contracted work for Eli Lilly and Company. RO is a consultant for Medical Decision Modelling Inc. and performs contracted work for Eli Lilly and Company. SZ is an employee of Tech Data Services Company and performs contracted work for Eli Lilly and Company.

Author contributions

Conception of work: RO

Design of the work: ASV, PM, AJ, SZ, RO, and SZ

Acquisition of data: RO

Data Analysis: ASV, PM, AJ, SZ, RO, and SZ

Data interpretation: AML, ASV, PM, AJ, SZ, RO, and SZ

Manuscript writing and critical revision: AML, ASV, PM, AJ, SZ, RO and SZ

Final approval: ASV, PM, SZ, AJ, RO, SZ and AML

Acknowledgements

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The ideas and opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. The authors would like to acknowledge the contributions of Jacqueline Brown (former employee of Eli Lilly and Company) and Mark Boye (Eli Lilly and Company) for the study concept/design. The authors would also like to thank Vengal Rao Pachava (Eli Lilly Services India Pvt. Ltd) for providing medical writing and editorial support.

Data availability statement

The data that support the findings of this study are available from the SEER-Medicare linked database (https://healthcaredelivery.cancer.gov/seermedicare/), but restrictions apply to the availability of these data, which were used under permission for the current study, and so are not publicly available. Data are available from SEER-Medicare upon reasonable request and with permission.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Consent to participate

Due to the nature of the study, consent to participate from patients was not required.

Consent to publication

The manuscript does not contain any individual person’s data in any form. Therefore, consent for publication was not required.

Previous presentations

A portion of these results was presented at the 2022 San Antonio Breast Cancer Symposium: December 6–10, 2022.

Additional information

Funding

This study was funded by Eli Lilly and Company. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute.