Adverse event-related costs for systemic metastatic breast cancer treatment among female Medicaid beneficiaries

Figures & data

Table 1. Demographic, clinical, and treatment characteristics of patients with metastatic breast cancer.

	All lines of therapy^d(n = 729)
Demographic characteristics^a
Age, mean (SD)	49.3 (9.3)
Race, n (%)
Black	327 (44.9)
White	309 (42.4)
Other	93 (12.8)
Health plan type, n (%)
Comprehensive (traditional/indemnity)	433 (59.4)
HMO	230 (31.6)
Other	66 (9.0)
Medicaid capitation, n (%)	314 (43.1)
Population density, n (%)
Metropolitan	534 (73.3)
Rural	195 (26.7)
Clinical characteristics^b
NCCI comorbidity index, mean (SD)	0.6 (1.1)
Prior breast cancer surgery, n (%)	88 (12.1)
Comorbid conditions, n (%)
Hypertension	271 (37.2)
Anxiety/depression	165 (22.6)
Diabetes	140 (19.2)
Cardiac arrhythmia	90 (12.3)
Site of metastasis, n (%)
Bone	474 (65.0)
Liver	229 (31.4)
Lung	207 (28.4)
Brain	127 (17.4)
Lymph nodes	65 (8.9)
Other site	343 (47.1)
Unspecified site	195 (26.7)
Total pre-period healthcare costs, PPPM, mean (SD)	$7266 ($9357)
Treatment characteristics^c
Concurrent line of therapy treatment, n (%)
Chemotherapy only	484 (66.4)
Biologic therapy only	25 (3.4)
Both biologic and chemotherapy	220 (30.2)
Previous systemic treatment, n (%)
None	270 (37.0)
Chemotherapy only	303 (41.6)
Biologic therapy only	13 (1.8)
Both biologic and chemotherapy	143 (19.6)
Line of therapy duration, mean (SD) days	216 (209)
Reason line of therapy ended, n (%)
Treatment discontinuation	365 (50.1)
End of continuous enrollment	208 (28.5)
Inpatient death	107 (14.7)
End of study period	49 (6.7)

HMO, health maintenance organization; NCCI, NCI adapted Charlson Comobidity Index; POS, point of service; PPPM, per-patient-per-month; SD, standard deviation.

a Demographic characteristics were measured at the index date at the start of each line of therapy.

b Clinical characteristics were measured during the pre-period which spanned to 180 days prior to the start of each line of therapy.

c Treatment characteristics were measured during each line of therapy post-index period.

d Basis for analysis was done at the line of therapy level and not at the patient level.

Table 2. Occurrence and incidence^a of AEs during lines of therapy.

	All lines of therapy(n = 729)
Number of unique AEs during line of therapy, mean (SD)	4.6 (2.8)
0 AEs, n (%)	33 (4.5)
1–3 AEs, n (%)	249 (34.2)
4–6 AEs, n (%)	279 (38.3)
7+ AEs, N (%)	168 (23.0)
Any AE all organ classes, n (%)	696 (95.5)
Incidence (per 100 person years)	1499.0
Constitutional, n (%)	574 (78.7)
Incidence (per 100 person years)	289.6
Dyspnea	307 (42.1)
Incidence	86.4
Dehydration	288 (39.5)
Incidence	82.9
Fatigue	251 (34.4)
Incidence	65.3
Insomnia	183 (25.1)
Incidence	49.2
Edema	118 (76.2)
Incidence	27.2
Alopecia	5 (0.7)
Incidence	1.1
Hematological, n (%)	481 (66.0)
Incidence (per 100 person years)	202.3
Anemia	395 (54.2)
Incidence	136.6
Leukopenia/Neutropenia	219 (30.0)
Incidence	59.8
Febrile Neutropenia	126 (17.3)
Incidence	30.8
Thrombocytopenia	80 (11.0)
Incidence	17.7
Gastrointestinal, n (%)	431 (59.1)
Incidence (per 100 person years)	169.3
Nausea/Vomiting	358 (49.1)
Incidence	123.1
Constipation	121 (16.6)
Incidence	27.9
Diarrhea	88 (12.1)
Incidence	20.5
Mucositis/Stomatitis	76 (10.4)
Incidence	17.2
Musculoskeletal, n (%)	3889 (53.4)
Incidence (per 100 person years)	165.9
Osteoporosis^b	175 (35.4)
Incidence	84.2
Peripheral Neuropathy	198 (27.2)
Incidence	52.8
Arthralgia	130 (17.8)
Incidence	32.0
Myalgia	28 (3.8)
Incidence	6.1
Other AEs, n (%)	116 (15.9)
Incidence (per 100 person years)	28.1
Rash	75 (10.3)
Incidence	17.1
Injection Site Reaction	26 (3.6)
Incidence	5.6
Cataract^b	18 (2.6)
Incidence	4.0
Overdose/hypersensitivity	5 (0.7)
Incidence	1.1
Menopausal symptoms^b, n (%)	11 (1.5)
Incidence (per 100 person years)	2.4
Cardiovascular, n (%)	55 (7.5)
Incidence (per 100 person years)	12.1
VTE	41 (5.6)
Incidence	8.9
Heart failure	9 (1.2)
Incidence	1.9
Stroke	6 (0.8)
Incidence	1.3

AE, adverse event; SD, standard deviation; VTE, venous thromboembolism.

a Incidence per 100 person years calculated by dividing the number of lines of therapy with an AE by the total time at risk for the AE.

b Baseline evidence precluded patients being considered at risk for that adverse event during the follow-up period.

Figure 1. Unadjusted mean PPPM AE-specific expenditures during all lines of therapy. AE, adverse event; PPPM, per-patient-per-month.

Figure 2. Adjusted mean PPPM total all-cause healthcare costs by number of AEs. AE, adverse event; PPPM, per-patient-per-month. Adjusted for all variables included in Supplemental Table S2.