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

Abstract

Objective:

To analyze medical costs and healthcare resource utilization (HRU) associated with everolimus-based therapy or chemotherapy among post-menopausal women with hormone-receptor-positive, human-epidermal-growth-factor-receptor-2-negative (HR+/HER2−) metastatic breast cancer (mBC).

Methods:

Patients with HR+/HER2− mBC who discontinued a non-steroidal aromatase inhibitor and began a new line of treatment with everolimus-based therapy or chemotherapy (index therapy/index date) between July 20, 2012 and April 30, 2014 were identified from two large claims databases. All-cause, BC-related, and adverse event (AE)-related medical costs (in 2014 USD) and all-cause HRU per patient per month (PPPM) were analyzed for both treatment groups across patients’ first four lines of therapies for mBC. Adjusted differences in costs and HRU between the everolimus and chemotherapy treatment group were estimated pooling all lines and using multivariable generalized linear models, accounting for difference in patient characteristics.

Results:

A total of 3298 patients were included: 902 everolimus-treated patients and 2636 chemotherapy-treated patients. Compared to chemotherapy, everolimus was associated with significantly lower all-cause (adjusted mean difference = $3455, p < 0.01) and BC-related ($2510, p < 0.01) total medical costs, with inpatient ($1344, p < 0.01) and outpatient costs ($1048, p < 0.01) as the main drivers for cost differences. Everolimus was also associated with significantly lower AE-related medical costs ($1730, p < 0.01), as well as significantly lower HRU (emergency room incidence rate ratio [IRR] = 0.83; inpatient IRR = 0.74; inpatient days IRR = 0.65; outpatient IRR = 0.71; BC-related outpatient IRR = 0.57; all p < 0.01).

Conclusions:

This retrospective claims database analysis of commercially-insured patients with HR+/HER2− mBC in the US showed that everolimus was associated with substantial all-cause, BC-related, and AE-related medical cost savings and less utilization of healthcare resources relative to chemotherapy.

Keywords::

• Everolimus
• Chemotherapy
• HR+/HER2−
• Metastatic breast cancer
• Costs
• Healthcare resource utilization

Transparency

Declaration of funding

Funding for this research was provided by Novartis.

Declaration of financial/other relationships

YH is an employee of Novartis and owns stock/stock options. NL, VK, AF, AK, MP, AG, and EQW are employees of Analysis Group Inc., which has received consultancy fees from Novartis. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Manuscript drafts were prepared by the authors with editorial assistance from Shelley Batts, PhD, a professional medical writer for Analysis Group, Inc. ultimately paid by the sponsor, Novartis. A synopsis of the current research was submitted to the NCCN 2016 annual meeting, which will take place in Hollywood, FL, during March 31–April 2, 2016.