Report proves more studies needed to guide health economics decisions in breast cancer management

Melanie Young was revelling in in her glitzy New York life. She owned a successful public relations business in the Big Apple city, specializing in food and drink. ai???I organized glamorous events, hobnobbed with famous chefs, and travelled the world tasting wines and attending cocktail conferencesai??i??for a living! Life was simply delicious!ai??? she remembered.

Then everything in her life turned completely upside down.

ai???I was diagnosed with stage 2A breast cancer after discovering a lump in my left breast during self-examination,ai??? Young wrote in Huffington Post recalling her experience. ai???Five years later, I came to a point where I considered applying for food stamps,ai??? she said. ai???My income was dried up and I was behind on my house payments. How did this happen to me?ai???

Financial stress in battling a major affliction such as breast cancer can be overwhelming to patients. Young, author of self-help book ai???Getting Things Off My Chest: A Survivorai??i??s Guide to Staying Fearless and Fabulous in the Face of Breast Cancerai??i??, found herself not alone in her strenuous financial journey.

She alluded to a 2014 study conducted by University of Michigan study which found that 25% of breast cancer survivors in the United States reported financial decline during treatment. One in three breast cancer survivors end up unemployed after treatment. Twelve percent of survivors were still paying off medical debt four years after treatment. Women who underwent chemotherapy had a 27% higher job-loss rate among more than 1,500 breast cancer survivors surveyed.

The burden of cancer on public finances is becoming a serious global concern. During the World Innovation Summit for Health (WISH) earlier this year, a new report ai???Delivering affordable cancer care: a value change to health systemsai??i?? presented a compelling body of evidence to illustrate the true scale of the disease and the rising cost to the global economy.

Delegates heard how the burden of cancer is only set to intensify with new cancer diagnoses expected to increase by around 16%ai??i??32% over the next 10 years. The report also gave startling predictions on the rise in incidence of cancer from 2008 to 2030: by 65% in high-income countries, 80% in middle-income countries, and 100% in the worldai??i??s poorest countries.

The report observed that more people are developing cancer and, as standards of care have risen, more are surviving and hence requiring longer-term care. In 2010, over 13 million people developed cancer and the worldwide costs of cancer care were conservatively estimated at USD$290 billion. By 2030, spending on cancer care is projected to leap to USD$458 billion.

Furthermore, cancer care costs directly affect the patients themselves and can lead to personal bankruptcy. According to the report, cancer patients in the UK have to spend A?570 (USD$862) on average per month on ancillary services and indirect costs of care. In the US, cancer patients have been shown to be over 2.5 times as likely to declare bankruptcy as other patients.

Health economics of breast cancer management

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A patient undergoing breast cancer screening

Breast cancer, specifically, is estimated to be diagnosed in a staggering number of quarter million women worldwide this year alone, according to the American Cancer Society. Yet not many research studies have looked into the cost-effectiveness of its treatments.

ai???Every year, researchers explore newer therapeutics which pave the way towards better treatment outcomes [of breast cancer]. However, these new therapeutics pose an extra burden on the already compromised economies all over the world,ai??? noted Dr. Omar Abdel-Rahman, professor of clinical oncology at Ain Shams University and also the Editor-in-Chief of the peer-reviewed open access journal Advances in Modern Oncology Research (AMOR).

ai???A frequently overlooked issue in measuring the advances in breast cancer management has been the impact of these advances on healthcare resource utilization,ai??? he observed.

Dr. Abdel-Rahman pointed out a recent study, published in AMORai??i??s December 2015 issue and researched by associate professor Chieh-Yu Liu from the School of Nursing at National Taipei University of Nursing and Health Sciences, which addresses the issue by analyzing the cost-effectiveness of healthcare resource utilization in the treatment of patients with inoperable advanced breast cancer (IABC).

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In his report, Liu observed that only few studies have examined the economic burden of IABC, ai???probably because the IABC population is smaller than that of operable ABC.ai??? Patients with IABC may require several conventional cytotoxic treatments and ai???if these treatments fail, the patients may receive targeted therapies, which further increased their economic burden,ai??? Liu stated.

ai???With the failure of conventional cytotoxic treatments, the economic burden and healthcare resource utilization of early or late second-line targeted therapies are crucial. However, this concern has been addressed rarely,ai??? he noted

Liu therefore tapped Taiwanai??i??s Bureau of National Health Insurance (BNHI) population-representative database of 1,629 newly diagnosed IABC patients between 2004 and 2006 who received at various time periods the cancer drugs capecitabine sequential to anthracycline-plus-taxane-based regimens (ATC) and trastuzumab sequential to anthracycline-plus-taxane-based regimens (ATT) as second-line treatment.

Capecitabine and trastuzumab have been widely used in advanced breast cancer treatments, Liu explained. ai???Capecitabine (trade name: XelodaAi??), an orally administered fluoropyrimidine carbamate, has been proven effective in monotherapy for metastatic breast cancer, metastatic colorectal cancer, and adjuvant colon cancer in recent years. In addition, trastuzumab (trade names: HerclonAi??, HerceptinAi??), a monoclonal antibody that interferes with the HER2/neu receptor, has been proven to improve clinical outcome and prolong the survival of patients with HER2-positive breast cancer and is the standard drug for both adjuvant and metastatic cancers,ai??? he stated.

Liu found that there were no significant differences observed in the ATC cohorts in terms of outpatient cost, inpatient cost and total costs, which implies that early or late administration of capecitabine drug did not affect its one-year healthcare costs.
Liuai??i??s study categorized the patients into three groups according to their year of diagnosis: 2004ai??i??2005, 2005ai??i??2006, and 2006ai??i??2007. ai???For each yearai??i??s cohort, we further classified patients with IABC into four groups receiving capecitabine or trastuzumab subsequent to anthracycline-plus-taxane-based treatments for 0ai??i??3, 3ai??i??6, 6ai??i??9, and 9ai??i??12 months,ai??? Liu reported.

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On the other hand, Liu noted, patients being prescribed the drug trastuzumab would face an economic burden. ai???For patients receiving trastuzumab, the IPD (inpatient) cost was significantly higher for the late-use group (9ai??i??12 months) compared with the other groups. However, the OPD (outpatient) and total costs were significantly higher for the early-use groups (0ai??i??3 and 3ai??i??6 months),ai??? he reported.

ai???This implies that physicians may prescribe trastuzumab for aggressive treatment or that the patients may prefer to receive trastuzumab combined with other chemotherapeutic treatments if first-line anthracycline- or taxane-based treatments fail,ai??? he opined.

The economic burden of IABC on patients receiving early or late second-line capecitabine or trastuzumab after the first-line anthracycline- or taxane-based treatments therefore substantially influences the overall cost of breast cancer care, Liu concluded in his reported. ai???[O]ur results facilitate the development of cost-effective evaluations of breast cancer therapies,ai??? he hoped.

Dr. Abdel-Rahman, echoing the findings, reiterated the importance of conducting and highlighting research studies such as Liuai??i??s to assist decision-makers in especially the low and middle-income countries dealing with breast cancer treatment programmes on a national scale.

ai???Cancer is a global health problem with profound healthcare, social and economic consequences,ai??? he furthered. ai???Proper assessment of aspects relevant to breast cancer health economics should be conducted after joint discussion between breast cancer physicians and experts in health economics and quality of medical care,ai??? he added.

ai???I believe that further health economics studies are eagerly needed to guide proper decisions in breast cancer management,ai??? Dr. Abdel-Rahman urged.

Liuai??i??s research can be accessed online on AMOR December 2015 issue.

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