Health care costs and utilization of a large insured female population with advanced or metastatic breast cancer by receipt of HER2-targeted agents

Figures & data

Table 1 Patient characteristics and clinical history by HER2-targeted agent status

	No HER2-targeted agents	HER2-targeted agents
All patients (n)	26,255	4,405
Age, years, mean (SD)	59.0 (12.6)	54.7 (11.1)^a
Urban	84.2%	84.2%
Payer
Commercial	72.6%	85.2%^a
Medicare	27.4%	14.8%^a
Insurance plan type
Comprehensive	14.1%	8.9%^a
EPO or PPO	52.4%	57.4%^a
POS	8.1%	8.4%^a
HMO	16.5%	15.1%^a
CDHP or HDHP	4.1%	4.9%^a
Unknown	4.8%	5.3%^a
Earlier stage breast cancer diagnosis	48.0%	48.3%
Surgery for breast cancer^d	16.6%	19.9%^a
Adjuvant/neoadjuvant treatment^d	52.7%	74.3%^a
Radiation therapy^d	9.6%^c	11.6%^b
Antineoplastic treatment^d
Any antineoplastic treatment^d	59.5%	75.8%^a
Treatment with hormone therapy	41.3%	29.7%^a
Treatment with chemotherapy	22.9%	45.l%^a
Treatment with biologic therapy	3.1%	58.6%^a
Treatment with HER2-targeted agents	0.0%	58.3%^a
NCI-CCI, mean (SD)^e	1.51 (0.94)	1.40 (0.82)^a
NCI-CCI, group^e
0	71.3%	76.3%^a
1	19.5%	17.5%^a
2	5.8%	4.2%^a
3+	3.4%	l.9%^a
Comorbidities
Anemia	9.2%	10.1%^c
Anxiety/depression	7.2%	8.0%
Cardiac arrhythmia	8.7%	5.7%^a
Cerebrovascular disease	4.0%	2.2%^a
Congestive heart failure	2.4%	2.1%
Coronary artery disease	6.4%	4.4%^a
Chronic obstructive pulmonary	4.4%	2.8%^a
disorder
Diabetes	13.3%	10.4%^a
Hypertension	36.0%	29.0%^a
Number of metastasis sites at index, mean (SD)	1.26 (0.63)	1.30 (0.69)^a
Disease stage
Stage III	54.8%	57.0%^b
Stage IV	45.2%	43.0%^b

Notes: n, number of patients meeting study selection criteria.

a P<0.001 versus no HER2-targeted agents;

b P<0.01 versus no HER2-targeted agents;

c P<0.05 versus no HER2-targeted agents;

d the denominator for the percentages is the number of patients with a diagnosis of an earlier stage breast cancer;

e National Cancer Institute adaptation of the Charlson Comorbidity Index.

Abbreviations: EPO, exclusive provider organizations; PPO, preferred provider organization plans; POS, point of service; HMO, health maintenance organization; CDHP, consumer-driven health plan, HDHP, high deductible health plan; SD, standard deviation; NCI-CCI, National Cancer Institute modification of the Charlson Comorbidity Index.

Table 2 Patient characteristics and clinical history among patients with HER2-targeted agents

	Patients with HER2-targeted agents
	Stage III	Stage IV	Age 18-44 years	Age 45-64 years	Age 65+ years
All patients (n)	2,512	1,893	778	2,985	642
Age, years, mean (SD)	53.7 (10.9)	56.0 (11.4)^a	38.9 (4.3)	54.8 (5.5)	73.3 (6.4)^a
Age group (years)
18–44	19.8%	14.8%^a	100.0%	0.0%	0.0%^a
45–64	67.7%	67.8%^a	0.0%	100.0%	0.0%^a
65+	12.5%	17.3%^a	0.0%	0.0%	100.0%^a
Urban	84.4%	84.1%^a	86.8%	83.4%	85.0%^a
Payer
Commercial	87.3%	82.4%^a	100.0%	99.6%	0.3%^a
Medicare	12.7%	17.6%^a	0.0%	0.4%	99.7%^a
Insurance plan type
Comprehensive	7.9%	10.3%^a	1.9%	3.9%	41.0%^a
EPO or PPO	58.0%	56.6%^a	58.4%	60.3%	42.4%^a
POS	7.6%	9.5%^a	10.3%	9.4%	1.9%^a
HMO	14.8%	15.5%^a	18.1%	14.8%	13.1%^a
CDHP or HDHP	6.0%	3.4%^a	6.8%	5.4%	0.2%^a
Unknown	5.7%	4.7%^a	4.5%	6.3%	1.6%^a
Earlier stage breast cancer diagnosis	29.9%	72.8%^a	43.6%	48.3%	54.2%^a
Surgery for breast cancer^d	20.0%	19.9%^a	23.9%	19.7%	17.0%^a
Adjuvant/neoadjuvant treatment^d	70.0%	76.6%^a	79.0%	73.9%	69.5%^a
Radiation therapy^d	7.7%	13.7%^a	13.9%	11.7%	8.9%^a
Antineoplastic treatment^d
Any antineoplastic treatment	71.9%	78.0%^a	82.9%	75.1%	72.1%^b
Treatment with hormone therapy	17.6%	36.3%^a	33.3%	27.6%	35.1%^b
Treatment with chemotherapy	54.4%	40.1%^a	50.7%	45.7%	37.4%^b
Treatment with biologic therapy	57.2%	59.4%^a	62.8%	59.5%	50.9%^b
Treatment with HER2-targeted agents	57.1%	58.9%^a	62.8%	59.2%	50.0%^a
NCI-CCI, mean (SD)^e	1.34 (0.73)	1.46 (0.91)^a	1.23 (0.53)	1.33 (0.73)	1.63 (1.04)^a
NCI-CCI group^e
0	77.7%	74.6%^c	87.5%	77.7%	56.7%^a
1	17.0%	18.2%^c	10.2%	17.2%	27.9%^a
2	3.8%	4.7%^c	1.9%	3.8%	8.7%^a
3+	1.5%	2.5%^c	0.4%	1.3%	6.7%^a
Comorbidities
Cardiac arrhythmia	5.7%	5.7%	2.4%	4.6%	14.6%^a
Cerebrovascular disease	2.2%	2.3%	0.4%	1.9%	6.2%^a
Congestive heart failure	1.3%	3.2%^a	0.9%	1.8%	4.8%^a
Coronary artery disease	3.7%	5.3%^b	1.0%	3.5%	12.8%^a
Hypertension	29.1%	28.8%	8.9%	28.6%	55.3%^a
Number of metastasis sites at index, mean (SD)	1.17 (0.50)	1.49 (0.85)^a	1.24 (0.62)	1.32 (0.71)	1.31 (0.68)^b
Disease stage
Stage III	100.0%	0.0%^a	63.9%	57.0%	48.9%^a
Stage IV	0.0%	100.0%^a	36.1%	43.0%	51.1%^a

Notes: n, number of patients meeting study selection criteria.

a P<0.001 versus corresponding HER2-targeted agent subgroup(s);

b P<0.05 versus corresponding HER2-targeted agent subgroup(s);

c P<0.01 versus corresponding HER2-targeted agent subgroup(s);

d the denominator for the percentages is the number of patients with a diagnosis of an earlier stage breast cancer;

e National Cancer Institute adaptation of the Charlson Comorbidity Index.

Abbreviations: EPO, exclusive provider organizations; PPO, preferred provider organization plans; POS, point of service; HMO, health maintenance organization; CDHP, consumer-driven health plan; HDHP, high deductible health plan; SD, standard deviation; NCI-CCI, National Cancer Institute modification of the Charlson Comorbidity Index.

Table 3 Utilization during follow-up period by HER2-targeted agent status

	No HER2-targeted agents (n=26,255)		HER2-targeted agents (n=4,405)		P-value
	Mean	SD	Mean	SD
All-cause monthly utilization (PPPM)^c
Inpatient admissions	0.13	0.70	0.10	0.48	0.006
Total inpatient days	0.64	2.68	0.45	1.59	<0.001
Outpatient utilization
ED visits	0.10	0.42	0.09	0.38	0.142
Outpatient office visits	1.57	1.33	1.89	1.09	<0.001
Radiation treatment^a	1.44	2.90	1.65	2.49	<0.001
Diagnostic radiology^a	1.59	2.25	1.93	1.95	<0.001
Laboratory services	3.70	5.47	4.84	4.45	<0.001
Other outpatient care^b	3.06	3.33	3.89	2.74	<0.001
Prescription fills	3.00	2.46	3.02	2.28	0.613
Breast cancer monthly utilization (PPPM)^c
Inpatient admissions	0.04	0.34	0.02	0.06	<0.001
Total inpatient days	0.12	1.22	0.06	0.51	0.001
Outpatient utilization
ED visits	0.02	0.18	0.02	0.17	1.000
Outpatient office visits	0.95	1.15	1.34	0.95	<0.001
Radiation treatment^a	1.10	2.42	1.27	2.08	<0.001
Diagnostic radiology^a	0.84	1.53	1.22	1.45	<0.001
Laboratory services	2.36	3.62	3.64	3.62	<0.001
Other outpatient care^b	1.56	1.94	2.47	1.97	<0.001
Prescription fills	0.26	0.32	0.25	0.32	0.057

Notes:

a Radiation treatment and diagnostic radiology encompass all outpatient radiology services during follow-up;

b other outpatient care includes all remaining outpatient services that are not reported individually;

c patient’s monthly utilization is calculated using the following formula: (patient’s total number visits or claims/patient’s total days of follow-up)×30 days.

Abbreviations: ED, emergency department; PPPM, per patient per month; SD, standard deviation.

Table 4 Utilization during follow-up period among HER2-targeted agent users

	Stage III (n=2,5 12)		Stage IV (n=l ,893)		P-value	Age 18-44 years (n=778)		Age 45-64 years (n=2,985)		Age 65+ years (n=642)		P-value
	Mean	SD	Mean	SD		Mean	SD	Mean	SD	Mean	SD
All-cause monthly utilization (PPPM)^c
Inpatient admissions	0.06	0.12	0.15	0.71	<0.001	0.07	0.15	0.11	0.56	0.10	0.27	0.169
Total inpatient days	0.21	0.65	0.78	2.26	<0.001	0.29	0.80	0.49	1.73	0.50	1.59	0.005
Outpatient utilization
ED visits	0.07	0.25	0.13	0.50	<0.001	0.08	0.23	0.09	0.43	0.11	0.23	0.346
Outpatient office visits	1.85	1.01	1.94	1.17	0.006	1.91	1.14	1.89	1.07	1.88	1.08	0.839
Radiation treatment^a	1.82	2.30	1.42	2.71	<0.001	1.84	2.57	1.64	2.48	1.46	2.41	0.016
Diagnostic radiology^a	1.76	1.55	2.15	2.35	<0.001	1.96	1.81	1.95	1.92	1.78	2.21	0.123
Laboratory services	4.45	3.74	5.35	5.20	<0.001	5.30	4.42	5.16	4.46	2.80	3.84	<0.001
Other outpatient care^b	3.59	2.13	4.29	3.33	<0.001	3.66	2.12	3.88	2.59	4.20	3.81	0.001
Prescription fills	2.84	2.06	3.26	2.52	<0.001	2.61	2.08	3.04	2.27	3.41	2.46	<0.001
Breast cancer monthly utilization (PPPM)^c
Inpatient admissions	0.02	0.05	0.01	0.06	<0.001	0.02	0.06	0.02	0.06	0.01	0.04	0.007
Total inpatient days	0.05	0.20	0.08	0.74	0.051	0.05	0.20	0.07	0.60	0.03	0.10	0.133
Outpatient utilization
ED visits	0.03	0.20	0.02	0.12	0.057	0.03	0.15	0.03	0.19	0.02	0.07	0.171
Outpatient office visits	1.32	0.90	1.36	1.01	0.166	1.39	1.05	1.35	0.94	1.22	0.87	0.002
Radiation treatment^a	1.65	2.12	0.76	1.90	<0.001	1.53	2.40	1.25	2.04	1.01	1.81	<0.001
Diagnostic radiology^a	1.21	1.36	1.24	1.57	0.498	1.34	1.53	1.25	1.41	0.95	1.53	<0.001
Laboratory services	3.39	3.08	3.97	4.21	<0.001	4.01	3.54	3.88	3.61	2.08	3.38	<0.001
Other outpatient care^b	2.34	1.57	2.65	2.39	<0.001	2.46	1.57	2.51	1.83	2.32	2.83	0.074
Prescription fills	0.24	0.28	0.27	0.36	0.002	0.29	0.32	0.25	0.32	0.22	0.30	0.001

Notes:

a Radiation treatment and diagnostic radiology encompass all outpatient radiology services during follow-up;

b other outpatient care includes all remaining outpatient services that are not reported individually;

c patient’s monthly utilization is calculated using the following formula: (patient’s total number visits or claims/patient’s total days of follow-up)×30 days.

Abbreviations: ED, emergency department; PPPM, per patient per month; SD, standard deviation.

Table 5 Unadjusted PPPM costs during follow-up by HER2-targeted agent status

	No HER2-targeted agents (n=26,255)		HER2-targeted agents (n=4,405)		P-value
	Mean	SD	Mean	SD
All-cause (PPPM)^a
Inpatient	$2,993	$14,646	$2,487	$11,672	0.029
Outpatient visits and services
ED visits	$83	$555	$109	$1,097	0.014
Outpatient office visits	$235	$391	$278	$395	<0.001
Radiation treatment^b	$624	$1,549	$800	$1,443	<0.001
Diagnostic radiology^b	$1,114	$2,977	$1,381	$2,687	<0.001
Laboratory services	$408	$1,149	$403	$849	0.795
Other outpatient care^c	$3,299	$4,813	$7,777	$7,267	<0.001
Prescription fills	$495	$905	$765	$1,384	<0.001
Total health care	$9,250	$17,060	$14,001	$15,223	<0.001
Breast cancer (PPPM)^a
Inpatient	$739	$7,893	$490	$3,048	0.038
Outpatient visits and services
ED visits	$32	$443	$61	$1,057	0.002
Outpatient office visits	$149	$340	$201	$346	<0.001
Radiation treatment^b	$494	$1,339	$633	$1,274	<0.001
Diagnostic radiology^b	$835	$2,436	$1,081	$2,302	<0.001
Laboratory services	$257	$944	$279	$649	0.125
Other outpatient care^c	$2,301	$4,111	$6,549	$6,807	<0.001
Prescription fills	$81	$243	$315	$910	<0.001
Total health care	$4,887	$10,368	$9,608	$8,852	<0.001

Notes:

a Patient’s monthly expenditure is calculated using the following formula: (patient’s total expenditures/patient’s total days of follow-up)×30 days;

b radiation treatment and diagnostic radiology encompass all outpatient radiology services during follow-up;

c other outpatient care includes all remaining outpatient services that are not reported individually.

Abbreviations: ED, emergency department; PPPM, per patient per month; SD, standard deviation.

Table 6 Unadjusted PPPM costs during follow-up in patients with HER2-targeted agents

	Stage III (n=2,5 12)		Stage IV (n=l ,893)		P-value	Age 1 8-44 years (n=778)		Age 45-64 years (n=2,985)		Age 65+ years (n=642)		P-value
	Mean	SD	Mean	SD		Mean	SD	Mean	SD	Mean	SD
All-cause (PPPM)^a
Inpatient	$1,510	$4,430	$3,783	$16,975	<0.001	$1,888	$3,992	$2,850	$13,919	$1,524	$3,591	0.010
Outpatient visits and services
ED visits	$104	$1,016	$116	$1,196	0.724	$125	$895	$115	$1,247	$60	$233	0.464
Outpatient office visits	$272	$371	$286	$424	0.258	$281	$238	$285	$412	$245	$460	0.064
Radiation treatment^b	$883	$1,376	$690	$1,521	<0.001	$1,025	$1,695	$807	$1,416	$494	$1,158	<0.001
Diagnostic radiology^b	$1,159	$2,119	$1,676	$3,270	<0.001	$1,502	$2,438	$1,448	$2,733	$925	$2,719	<0.001
Laboratory services	$404	$881	$403	$805	0.969	$482	$1,012	$408	$723	$288	$1,122	<0.001
Other outpatient care^c	$7,634	$6,903	$7,966	$7,722	0.133	$8,802	$7,676	$7,985	$7,377	$5,562	$5,634	<0.001
Prescription fills	$531	$1,034	$1,076	$1,695	<0.001	$784	$1,575	$767	$1,372	$733	$1,184	0.782
Total health care	$12,497	$10,023	$15,996	$19,977	<0.001	$14,889	$1 1,099	$14,666	$17,076	$9,832	$8,065	<0.001
Breast cancer (PPPM)^a
Inpatient	$590	$2,653	$356	$3,500	0.012	$562	$1,705	$541	$ 3,587	$162	$527	0.013
Outpatient visits and services
ED visits	$67	$970	$52	$1,163	0.624	$68	$791	$69	$1,218	$15	$106	0.496
Outpatient office visits	$198	$304	$205	$395	0.505	$208	$216	$206	$347	$168	$450	0.031
Radiation treatment^b	$797	$1,295	$416	$1,213	<0.001	$850	$1,570	$639	$1,257	$340	$821	<0.001
Diagnostic radiology^b	$958	$1,772	$1,243	$2,850	<0.001	$1,194	$2,130	$1,135	$2,304	$693	$2,454	<0.001
Laboratory services	$ 286	$ 641	$ 271	$ 658	0.455	$ 332	$ 894	$288	$598	$177	$497	<0.001
Other outpatient care^c	$6,539	$6,566	$6,561	$7,116	0.916	$7,334	$7,188	$6,782	$6,930	$4,510	$5,194	<0.001
Prescription fills	$175	$672	$500	$1,127	<0.001	$322	$979	$326	$923	$257	$750	0.212
Total health care	$9,61 1	$8,384	$9,604	$9,440	0.981	$10,869	$9,1 16	$9,986	$9,1 17	$6,322	$6,107	<0.001

Notes:

a Patient’s monthly expenditure is calculated using the following formula: (patient’s total expenditures/patient’s total days of follow-up)×30 days;

b radiation treatment and diagnostic radiology encompass all outpatient radiology services during follow-up;

c other outpatient care includes all remaining outpatient services that are not reported individually.

Abbreviations: ED, emergency department; PPPM, per patient per month; SD, standard deviation.

Table 7 Adjusted all-cause and breast cancer-related expenditures per patient per month

	All-cause health care expenditures			Breast cancer-related expenditures
	Mean	Lower 95% CL	Upper 95% CL	Mean	Lower 95% CL	Upper 95% CL
HER2-targeted agent status (n=30,660)
HER2-targeted agents	$12,919	$12,553	$13,296	$8,573	$8,293	$8,864
No HER2-targeted agents	$8,822	$8,720	$8,926	$4,621	$4,559	$4,685
Incremental expenditures	$4,096	$3,713	$4,481	$4,015	$3,723	$4,307
HER2-targeted agent patients (n=4,405)
Disease stage
Stage IV	$16,335	$15,781	$16,909	$9,995	$9,621	$10,369
Stage III	$11,816	$11,471	$12,171	$8,855	$8,572	$9,139
Incremental expenditures	$4,519	$3,855	$5,183	$1,140	$671	$1,609
Age group, years
18-44	$15,123	$14,338	$15,951	$10,765	$10,145	$11,385
45-64	$14,219	$13,845	$14,603	$9,727	$9,445	$10,010
65+	$9,625	$9,014	$10,278	$6,439	$5,972	$6,907
Incremental expenditures	$904	$13	$1,795	$1.308	$626	$1,989
age 18-44 years versus age 45-64 years
Incremental expenditures	−$4,594	−$5,618	−$3,570	−$3,288	−$4,026	−$2,550
age 65+ years versus age 45-64 years

Abbreviation: CL, confidence limit.

Table 8 Multivariate results for all patients

Parameter	Total expenditures				Breast cancer-related expenditures
	Estimate	Lower 95% CL	Upper 95% CL	P-value	Estimate	Lower 95% CL	Upper 95% CL	P-value
Intercept	9.045	9.018	9.072	<0.001	8.728	8.696	8.759	<0.001
HER2-targeted agents	0.381	0.350	0.413	<0.001	0.618	0.582	0.654	<0.001
Stage IV metastasis (reference stage III)	0.410	0.386	0.433	<0.001	0.037	0.010	0.065	0.009
Age group, years (reference age 45-64)
Age 18-44	0.163	0.129	0.197	<0.001	0.182	0.142	0.221	<0.001
Age 65+	−0.432	−0.463	−0.401	<0.001	−0.599	−0.635	−0.563	<0.001
Population density: rural/	−0.013	−0.043	0.018	0.411	0.006	−0.030	0.042	0.738
unknown (reference urban)
USA geographic region (reference South)
Northeast	−0.002	−0.035	0.031	0.901	0.007	−0.032	0.046	0.720
North Central	−0.044	−0.072	−0.016	0.002	0.003	−0.030	0.035	0.873
West	−0.011	−0.042	0.020	0.494	−0.068	−0.105	−0.032	0.000
Unknown	0.042	−0.079	0.163	0.493	0.165	0.025	0.306	0.021
Insurance plan type (reference, preferred provider/exclusive provider organizations)
Comprehensive	−0.233	−0.271	−0.195	<0.001	−0.266	−0.311	−0.222	<0.001
Point of service	−0.084	−0.125	−0.043	<0.001	−0.152	−0.200	−0.104	<0.001
Health maintenance organization	−0.211	−0.243	−0.180	<0.001	−0.257	−0.294	−0.221	<0.001
Consumer-driven health plan/high deductible health plan	0.072	0.017	0.127	0.010	0.061	−0.003	0.125	0.062
Unknown	−0.122	−0.174	−0.069	<0.001	−0.058	−0.119	0.004	0.068
Breast cancer surgery	−0.184	−0.219	−0.149	<0.001	−0.216	−0.256	−0.175	<0.001
Radiation therapy	0.029	−0.024	0.082	0.287	−0.150	−0.212	−0.088	<0.001
Antineoplastic use in pre-period
Hormone	−0.209	−0.238	−0.180	<0.001	−0.334	−0.368	−0.300	<0.001
Chemotherapy	0.106	0.072	0.141	<0.001	0.060	0.020	0.100	0.004
Non-HER2 biologic	0.338	0.246	0.430	<0.001	0.336	0.228	0.443	<0.001
National Cancer Institute adaptation	0.092	0.071	0.114	<0.001	−0.024	−0.050	0.002	0.069
of CCI
Comorbid conditions
Anemia	0.104	0.065	0.143	<0.001	−0.002	−0.047	0.043	0.923
Anxiety	0.000	−0.043	0.042	0.985	0.010	−0.040	0.060	0.697
Depression	0.175	0.134	0.215	<0.001	0.124	0.077	0.171	<0.001
Cardiac arrhythmia	0.066	0.025	0.107	0.002	0.061	0.014	0.109	0.012
Cerebrovascular disease	−0.121	−0.184	−0.058	<0.001	−0.175	−0.250	−0.101	<0.001
Congestive heart failure	0.066	−0.012	0.145	0.097	−0.171	−0.262	−0.080	<0.001
Coronary artery disease	−0.024	−0.072	0.025	0.339	0.014	−0.043	0.071	0.639
Chronic obstructive pulmonary	0.055	−0.006	0.115	0.075	−0.083	−0.153	−0.013	0.020
disorder
Diabetes	0.004	−0.040	0.047	0.871	0.024	−0.027	0.076	0.354
Hypertension	0.044	0.019	0.068	0.001	0.041	0.013	0.070	0.005

Abbreviations: CL, confidence limit; CCI, Charlson Comorbidity Index.

Table 9 Multivariate results for patients with HER2-targeted agents

Parameter	Total expenditures				Breast cancer-related expenditures
	Estimate	Lower 95% CL	Upper 95% CL	P-value	Estimate	Lower 95% CL	Upper 95% CL	P-value
Intercept	9.825	9.766	9.884	<0.001	9.361	9.298	9.424	<0.001
Stage III metastasis (reference stage IV)	−0.324	−0.371	−0.277	<0.001	−0.121	−0.172	−0.070	<0.001
Age group, years (reference age 45-64 years)
Age 18-44	0.062	0.003	0.121	0.041	0.101	0.037	0.165	0.002
Age 65 +	−0.390	−0.463	−0.317	<0.001	−0.413	−0.493	−0.332	<0.001
Population density: rural/unknown (reference urban)	−0.004	−0.065	0.057	0.899	−0.027	−0.093	0.040	0.430
USA geographic region (reference South)
Northeast	0.098	0.030	0.165	0.005	0.088	0.015	0.162	0.019
North Central	−0.008	−0.063	0.046	0.767	0.042	−0.016	0.101	0.157
West	−0.010	−0.073	0.054	0.771	−0.004	−0.073	0.065	0.917
Unknown	−0.151	−0.418	0.115	0.265	−0.014	−0.303	0.275	0.924
Health plan type (reference preferred provider/exclusive provider organizations)
Comprehensive	−0.146	−0.232	−0.059	0.001	−0.171	−0.268	−0.074	0.001
Point of service	−0.131	−0.212	−0.050	0.002	−0.175	−0.263	−0.088	<0.001
Health maintenance organization	−0.144	−0.207	−0.080	<0.001	−0.177	−0.246	−0.108	<0.001
Consumer-driven health plan/high deductible health plan	0.085	−0.018	0.187	0.105	0.122	0.011	0.233	0.031
Unknown	0.002	−0.101	0.104	0.977	0.113	0.002	0.224	0.046
Breast cancer surgery	−0.144	−0.211	−0.078	<0.001	−0.111	−0.183	−0.039	0.002
Radiation therapy	−0.095	−0.192	0.002	0.055	−0.400	−0.507	−0.293	<0.001
Antineoplastic use in pre-period
Hormone	−0.145	−0.209	−0.082	<0.001	−0.135	−0.205	−0.065	0.000
Chemotherapy	−0.156	−0.211	−0.102	<0.001	−0.210	−0.270	−0.151	<0.001
Non-HER2 biologic	0.121	−0.103	0.345	0.289	0.281	0.034	0.528	0.026
National Cancer Institute adaptation of CCI	0.022	−0.027	0.072	0.371	−0.019	−0.073	0.034	0.480
Comorbid conditions
Anemia	−0.065	−0.140	0.010	0.087	−0.080	−0.162	0.002	0.056
Anxiety	0.067	−0.015	0.149	0.110	0.120	0.032	0.209	0.008
Depression	0.175	0.094	0.255	<0.001	0.069	−0.018	0.157	0.121
Cardiac arrhythmia	0.032	−0.065	0.129	0.518	0.021	−0.083	0.125	0.695
Cerebrovascular disease	0.198	0.039	0.357	0.015	0.102	−0.070	0.275	0.245
Congestive heart failure	0.037	−0.129	0.202	0.663	−0.015	−0.192	0.162	0.870
Coronary artery disease	0.092	−0.023	0.207	0.118	0.049	−0.074	0.172	0.434
Chronic obstructive pulmonary disorder	−0.023	−0.166	0.119	0.747	0.009	−0.146	0.164	0.914
Diabetes	0.156	0.058	0.254	0.002	0.107	0.000	0.213	0.051
Hypertension	−0.032	−0.084	0.021	0.235	0.014	−0.043	0.070	0.633

Abbreviations: CL, confidence limit; CCI, Charlson Comorbidity Index.