Patients With Breast Cancer Experience High Economic Burden and Lower HRQoL: Literature Review

In a systematic literature review, researchers summarized the economic and health-related quality of life (HRQoL) outcomes experienced by patients with early-stage hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HR+/HER2−) breast cancer. The authors looked at English language publications containing relevant data on this patient population, particularly for adult patients with localized invasive breast ductal adenocarcinoma stage T1c-T2, clinical node (cN) stage cN1-cN2, or T3-T4, cN0-cN2. They pulled data from the Embase, MEDLINE, Tufts Cost Effectiveness Analysis (CEA), EconLit, and Center for Reviews and Dissemination (CRD) York databases from the inception of the databases until May 10, 2023. They also searched relevant conference proceedings that were held from 2020-2023.

In total, 10 studies reporting on economic burden were included in the review. Six were from North America, two were from Europe, one was from Oceania, and one was an international study. The data showed that the total health care cost per patient in Canada was CAD$22 662 (US $15 342.33), and in the US the total cost ranged from $10 391 to $31 458. In Europe, the total cost was €11 516 (US $12 458.58) in Portugal and ranged from £4,765 to £5,987 (US $5999.10-$7537.59) in the United Kingdom. The total cost in New Zealand was NZ$28 481 (US $17 201.10).

The review also showed that costs were higher among patients receiving chemotherapy compared to those receiving endocrine therapy. In terms of health care resource utilization (HCRU), patients with stage II-III HR+/HER2− breast cancer receiving chemotherapy reported significantly high rates of hospitalization compared to those receiving endocrine therapy (54% vs 9%, respectively).

The authors reviewed eight studies that reported on HRQoL, including five cross-sectional studies and three randomized controlled trials. Results showed that there was clinically meaningful deterioration from baseline among 36% of patients who received neoadjuvant ribociclib plus letrozole and in 68% of patients who received chemotherapy. This deterioration was especially evident in patients experiencing high work productivity impairment vs those who had lower work productivity impairment. In addition, chemotherapy was associated with significant deterioration in cognitive and/or sexual function and symptom burden.

Overall, the combined results in the literature revealed that current treatment regimens for early-stage HR+/HER2− breast cancer were associated with high overall direct costs through patients’ use of both inpatient and outpatient resources. The treatment was also associated with a detrimental impact on their HRQoL.

Reference

Earla JR, Singh P, Bozkaya D, Nathani J, Pandey P, Haiderali A. Understanding the humanistic and economic burden associated with early-stage HR+/HER2− breast cancer: a systematic literature review. Presented at: International Society for Pharmacoeconomics and Outcomes Research Conference; May 5-8, 2024;  Atlanta, GA, and virtual; Abstract EE43.