The economic impact of disease progression and death in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer patients: using Korean nationwide health insurance claims data

Abstract

Objectives

Recognizing the value of anticancer treatments based on progression-free survival and overall survival may help decision making in healthcare policy. We aimed to measure and compare the impact of disease progression and terminal state prior to death on healthcare costs in HR+, HER2- ABC patients.

Methods

We conducted a retrospective study using Korean nationwide health insurance claims database between 1 September 2012 and 31 August 2017. The impact of disease progression was estimated by measuring the average incremental monthly cost per patient during 1 year after progression compared to 1 year before progression. Death-related costs per patient per month (PPPM) were measured for those who died within 1 year after progression. Generalized estimating equation (GEE) was used to estimate the variations in PPPM costs by progression and death with adjustment for clinical factors.

Results

After progression, 1,636 patients expensed $2,892 per month more on average than before progression ($3762 vs. $870). The GEE analysis with adjustment for baseline characteristics showed that PPPM costs increased by 3.46 folds (95% CI = 3.06–3.93) after progression. Also, PPPM costs were 1.74 (95%CI = 1.43–2.12) times higher in patients who died within 1 year after progression relative to survived patients. When considering the interaction between progression and death, deceased patients showed higher increased ratio of PPPM costs after progression (4.91; p=value<.0001) than survived patients (2.95; 95% CI = 2.61–3.34).

Conclusions

From the payer’s perspective, more healthcare costs incurred during the progression state than terminal state in HR+, HER2- ABC patients. The impact of disease progression emphasizes the importance of effectively treating HR+, HER2- ABC patients.

Keywords:

• Advanced breast cancer
• progression
• healthcare costs

This article is related to:

Cost/benefit evaluations in low-middle/upper-middle income countries: biases about “out of pocket money”

Transparency

Declaration of funding

This study was funded by Novartis.

Declaration of financial/other relationships

HK is an employee of Novartis. JAP, SYY, JYS, and SKP have no conflicts of interest to declare.

Author contributions

SKP, JAP, and HK contributed to conception and design of the study. SKP and JAP contributed to acquisition of data. SKP contributed to analysis and interpretation of data. SKP, JAP, SYY, and JYS contributed to drafting the article. All authors contributed to reviewing the article and approval of the final article.

Acknowledgements

The authors would like to thank Tae-Yong Kim, MD of Seoul National University Hospital for his expert advice and intellectual guidance in study design and Kayoung Jeong, MD of Novartis Korea for providing insightful suggestions in the data analysis.

Ethics approval and informed consent

This study was approved by `the Institutional Review Board (IRB) of Sungkyunkwan University (IRB File no. SKKU 2018-04-017-002). The claims data access was approved and provided by HIRA. Informed consent was waived by the IRB because HIRA claims data are anonymized and de-identified publicly available information.