Comparison of medical costs and healthcare resource utilization of post-menopausal women with HR+/HER2− metastatic breast cancer receiving everolimus-based therapy or chemotherapy: a retrospective claims database analysis

Figures & data

Table 1. Baseline characteristics.

	Line 1		Line 2		Line 3		Line 4
	Everolimus	Chemotherapy	Everolimus	Chemotherapy	Everolimus	Chemotherapy	Everolimus	Chemotherapy
	(n = 66)	(n = 553)	(n = 261)	(n = 823)	(n = 331)	(n = 1004)	(n = 282)	(n = 1030)
Descriptive characteristics
Age at index date (years), mean ± SD [median]	62.8 ± 9.0 [62.7]	62.4 ± 10.3 [61.0]	60.9 ± 9.7 [60.4]	60.9 ± 10.2 [60.1]	59.5 ± 10.4 [59.8]	60.3 ± 9.8 [59.9]	60.7 ± 10.7 [60.9]	59.4 ± 10.1 [58.9]*
Insurance type, n (%)
Medicare	19 (28.8%)	195 (35.3%)	59 (22.6%)	234 (28.4%)	82 (24.8%)	269 (26.8%)	80 (28.4%)	241 (23.4%)
Medicare advantage	3 (4.5%)	5 (0.9%)*	5 (1.9%)	9 (1.1%)	0 (0.0%)	14 (1.4%)*	1 (0.4%)	7 (0.7%)
Medicare supplemental	12 (18.2%)	148 (26.8%)	41 (15.7%)	174 (21.1%)	66 (19.9%)	195 (19.4%)	63 (22.3%)	181 (17.6%)
Other medicare	4 (6.1%)	42 (7.6%)	13 (5.0%)	51 (6.2%)	16 (4.8%)	60 (6.0%)	16 (5.7%)	53 (5.1%)
Private insurance only	47 (71.2%)	358 (64.7%)	202 (77.4%)	589 (71.6%)	249 (75.2%)	735 (73.2%)	202 (71.6%)	789 (76.6%)
mBC characteristics,^a n (%)
De novo	3 (4.5%)	33 (6.0%)	67 (25.7%)	204 (24.8%)	116 (35.0%)	283 (28.2%)*	70 (24.8%)	326 (31.7%)*
Non-de novo	62 (93.9%)	520 (94.0%)	169 (64.8%)	581 (70.6%)	166 (50.2%)	593 (59.1%)**	140 (49.6%)	524 (50.9%)
Type of mBC unknown	1 (1.5%)	0 (0.0%)	25 (9.6%)	38 (4.6%)**	49 (14.8%)	128 (12.7%)	72 (25.5%)	180 (17.5%)**
Number of organ-level metastatic sites, mean ± SD [median]	1.3 ± 1.0 [1]	1.4 ± 1.1 [1]	1.7 ± 1.1 [1]	1.8 ± 1.3 [2]	1.9 ± 1.2 [2]	2.0 ± 1.4 [2]	2.0 ± 1.3 [2]	2.1 ± 1.4 [2]
CCI, mean ± SD [median]	9.5 ± 1.7 [9]	9.0 ± 1.2 [9]	8.8 ± 1.0 [9]	9.1 ± 1.3 [9]***	8.8 ± 1.0 [9]	9.1 ± 1.2 [9]***	8.9 ± 1.0 [9]	9.0 ± 1.1 [9]
Prior use of chemotherapy for mBC, n (%)	0 (0.0%)	0 (0.0%)	28 (10.7%)	305 (37.1%)***	105 (31.7%)	602 (60.0%)***	162 (57.4%)	777 (75.4%)***
Time from initiation of last adjuvant endocrine therapy to mBC diagnosis (months), mean ± SD [median]	18.9 ± 20.8 [12.2]	28.9 ± 26.5 [21.3]**	23.7 ± 22.7 [16.7]	22.6 ± 23.3 [14.5]	20.6 ± 22.0 [10.7]	22.0 ± 22.0 [15.1]	15.9 ± 18.1 [10.0]	17.6 ± 18.4 [11.9]

SD, standard deviation; CCI, Charlson comorbidity index; *p < 0.05, **p < 0.01, ***p < 0.001.

^aDe novo patients are defined as being diagnosed for mBC within 3 months of their first diagnosis for BC; non-de novo patients are defined as patients whose mBC diagnosis date is at least 3 months after their first BC diagnosis. Both de novo and non-de novo patients are required to have at least 12 months of continuous eligibility prior to the BC diagnosis date; otherwise, they are considered to have unknown mBC type.

Figure 1. Sample selection. *Total lines of therapy may exceed the number of patients if patients receive more than one line of the same therapy type.

Table 2. Comparison of medical services costs^a between everolimus and chemotherapy.

Costs (in 2014 $), mean ± SD	Line 1			Line 2			Line 3			Line 4			Pooled (lines 1–4)
	Everolimus (n = 66)	Chemotherapy (n = 553)	Unadjusted difference	Everolimus (n = 261)	Chemotherapy (n = 823)	Unadjusted difference	Everolimus (n = 331)	Chemotherapy (n = 1004)	Unadjusted difference	Everolimus (n = 282)	Chemotherapy (n = 1030)	Unadjusted difference	Adjusted difference
Total all-cause medical service costs	5191 ± 5696	8889 ± 14344	3698*	5023 ± 7905	8885 ± 20551	3862***	6158 ± 18987	8493 ± 38625	2335***	4790 ± 11276	8770 ± 19118	3980***	3455**
Inpatient costs	1814 ± 4761	3700 ± 12083	1886	1746 ± 6512	4335 ± 19932	2589	2833 ± 18450	4156 ± 38007	1323	1580 ± 10004	3907 ± 16840	2327	1897**
Emergency room costs	161 ± 635	193 ± 846	33	74 ± 263	139 ± 956	65	105 ± 328	164 ± 1211	59	136 ± 571	219 ± 1222	84	65**
Outpatient costs	3058 ± 3712	4757 ± 7664	1699**	3066 ± 4189	4200 ± 5470	1134***	3010 ± 4626	3977 ± 5215	967***	2828 ± 4213	4375 ± 6914	1547***	1395**
Other medical service  costs	158 ± 450	239 ± 1012	81	138 ± 559	211 ± 1014	73	209 ± 798	195 ± 887	−14	246 ± 1287	269 ± 1052	23	27
Total BC-related medical service costs	3767 ± 4972	6446 ± 12940	2679	3993 ± 6744	6090 ± 12901	2098***	5155 ± 18570	6846 ± 37826	1692**	3355 ± 4446	6929 ± 15919	3574***	2510**
Inpatient costs	1101 ± 3699	2761 ± 10796	1660	1313 ± 5464	2737 ± 12276	1423	2480 ± 18225	3446 ± 37323	966	739 ± 2356	2861 ± 13304	2122	1344**
Emergency room costs	47 ± 157	95 ± 699	47*	39 ± 218	46 ± 305	6	52 ± 238	61 ± 483	10	40 ± 275	115 ± 1019	75	31*
Outpatient costs	2533 ± 3601	3444 ± 6881	911	2595 ± 3872	3209 ± 4483	614**	2475 ± 3810	3212 ± 4745	737***	2384 ± 3677	3760 ± 6727	1376***	1048**
Other medical service  costs	85 ± 281	146 ± 927	60	45 ± 230	99 ± 420	54*	147 ± 723	127 ± 679	−20	192 ± 1170	193 ± 916	1*	26
AE-related medical service costs	1637 ± 3368	3340 ± 10549	1704	1474 ± 5791	3694 ± 18442	2220**	1509 ± 4514	3741 ± 36688	2233***	1512 ± 9832	2882 ± 9907	1370**	1730**

Difference, difference of chemotherapy group and everolimus group; SD, standard deviation; BC, breast cancer; AE, adverse event; *p < 0.05, **p < 0.01, ***p < 0.001.

^aMedical service costs include costs from medical claims that are not associated with drug administration.

Table 3. Comparison of healthcare resource utilization between everolimus and chemotherapy^a.

	Line 1			Line 2			Line 3			Line 4			Pooled (lines 1–4)
	Everolimus	Chemotherapy	Unadjusted	Everolimus	Chemotherapy	Unadjusted	Everolimus	Chemotherapy	Unadjusted	Everolimus	Chemotherapy	Unadjusted	Adjusted
	(n = 66)	(n = 553)	IRR	(n = 261)	(n = 823)	IRR	(n = 331)	(n = 1004)	IRR	(n = 282)	(n = 1030)	IRR	IRR
Emergency care visits	0.142	0.201	0.71	0.123	0.141	0.87	0.129	0.138	0.93	0.120	0.177	0.68**	0.83**
Inpatient admissions	0.059	0.097	0.61*	0.052	0.076	0.69*	0.053	0.063	0.84	0.049	0.074	0.66**	0.74**
Inpatient days	0.347	0.729	0.48**	0.408	0.685	0.60*	0.381	0.466	0.82	0.307	0.589	0.52**	0.65**
Emergency room visits	0.083	0.104	0.79	0.071	0.065	1.09	0.076	0.075	1.01	0.071	0.103	0.69*	0.90
Outpatient visits	3.442	5.500	0.63**	3.389	4.764	0.71**	3.298	4.497	0.73**	3.207	4.715	0.68**	0.71**
BC-related outpatient visits	2.507	3.717	0.67**	2.309	3.389	0.68**	2.302	3.372	0.68**	2.225	3.658	0.61**	0.66**
Other medical services	0.466	0.915	0.51**	0.436	0.804	0.54**	0.545	0.676	0.81	0.491	0.799	0.61**	0.67**
AE-related HRU	0.760	1.635	0.46**	0.871	1.487	0.59**	0.782	1.449	0.54**	0.890	1.556	0.57**	0.59**
Inpatient admissions	0.053	0.086	0.61*	0.047	0.069	0.69*	0.046	0.055	0.84	0.042	0.065	0.64**	0.73**
Emergency room visits	0.053	0.056	0.94	0.046	0.039	1.19	0.043	0.051	0.85	0.042	0.057	0.74	0.93
Outpatient visits	0.581	1.355	0.43**	0.710	1.301	0.55**	0.635	1.224	0.52**	0.748	1.293	0.58**	0.57**
Other medical services	0.073	0.138	0.53	0.068	0.079	0.86	0.059	0.119	0.49*	0.058	0.140	0.42**	0.59**

IRR, incidence rate ratio of everolimus group to chemotherapy group; AE, adverse event; *p < 0.05, **p < 0.01, ***p < 0.001.

^aThe chemotherapy group was used as the reference group. An IRR <1 suggests that the everolimus group utilized less resources than the chemotherapy group, while an IRR >1 suggests that the everolimus group utilized more resources than the chemotherapy group.