ABSTRACT

Background

Real-world evidence specific to HR+/HER2– metastatic breast cancer (MBC) prior to introduction of CDK4/6 inhibitors is limited. In an effort to provide context for the introduction of new treatments, we assessed treatment patterns, adverse events, productivity loss, and direct/indirect economic burden in a privately insured population of patients with HR+/HER2– MBC.

Research design and methods

Using a retrospective cohort design, patients aged 18–64 years, selected from MarketScan databases (2007–2014), were analyzed using descriptive and multivariable methods.

Results

Among 5,563 eligible patients, endocrine therapy was the most common first-line (1L) therapy; its utilization trended downward from 63% (1L) to 23% (4L), with a simultaneous increase in chemotherapy use, 25% (1L) to 50% (4L). Two hundred and seventy-eight unique treatment regimens were used in the 1L setting. The average per patient monthly all-cause costs were $14,424. The 12-month indirect costs for short-term disability were substantially higher in MBC patients ($10,397) than in matched noncancer patients ($394).

Conclusion

The increasing use of chemotherapy as patients progressed to second and later lines and the substantial direct/indirect economic burden underscore an unmet need. The high number of 1L regimens highlights significant heterogeneity and a lack of consensus related to the management of HR+/HER2– MBC in routine practice.

中文翻译：

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美国私人保险 HR+/HER2- 转移性乳腺癌患者群体的治疗模式、不良事件以及直接和间接经济负担

摘要

背景

在引入 CDK4/6 抑制剂之前，针对 HR+/HER2- 转移性乳腺癌 (MBC) 的真实世界证据有限。为了为引入新疗法提供背景，我们评估了私人保险的 HR+/HER2–MBC 患者群体的治疗模式、不良事件、生产力损失和直接/间接经济负担。

研究设计与方法

使用回顾性队列设计，使用描述性和多变量方法分析从 MarketScan 数据库（2007-2014 年）中选择的 18-64 岁的患者。

结果

在 5,563 名符合条件的患者中，内分泌治疗是最常见的一线 (1L) 治疗；其利用率从 63% (1L) 下降到 23% (4L)，同时化疗的使用量从 25% (1L) 上升到 50% (4L)。在 1L 环境中使用了 278 种独特的治疗方案。每位患者每月的平均全因费用为 14,424 美元。MBC 患者的 12 个月短期残疾间接费用（10,397 美元）明显高于匹配的非癌症患者（394 美元）。

结论

随着患者进展到二线及更高线，化疗使用的增加以及巨大的直接/间接经济负担突显了未满足的需求。大量 1L 方案凸显了在常规实践中与 HR+/HER2-MBC 管理相关的显着异质性和缺乏共识。