A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer

Breast Cancer Res Treat. 2021 Feb;185(3):807-815. doi: 10.1007/s10549-020-05976-w. Epub 2020 Oct 22.

Abstract

Purpose: We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC).

Methods: We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I-III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs.

Results: Overall, 4535 patients with stage I-III and 354 with stage IV HER2+ BC were identified. Most patients with stage I-III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I-III HER2+ BC.

Conclusion: Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC.

Keywords: Breast neoplasms; Drug therapy; Epidemiologic studies; Health expenditures; Health services research; Receptor ErbB-2.

MeSH terms

  • Adult
  • Breast Neoplasms* / epidemiology
  • Breast Neoplasms* / therapy
  • Female
  • Humans
  • Neoplasm Recurrence, Local
  • Ontario / epidemiology
  • Receptor, ErbB-2 / genetics
  • Trastuzumab / therapeutic use

Substances

  • Receptor, ErbB-2
  • Trastuzumab