Impact of Home Hospitalization on the Cost of Care for 1ST Line Treatment of Locally Advanced or Metastatic HER2+ Breast Cancer

OBJECTIVES: Anti-HER2 targeted therapies are the standard of care for first line treatment locally advanced or metastatic HER2+ breast cancer. In France, these treatments are mainly administered at hospital while at home hospitalization, less costly, could be organized leading to structural savings for healthcare system.

METHODS: A cost model was used to estimate the cost of an episode of care with anti-HER2 targeted therapy fully administered at hospital vs full home hospitalization for a patient with a locally advanced or metastatic HER2+ breast cancer. The episode of care is based on real life practice database PRM (Personalized Reimbursement Model) that follows treatments’ administration of HER2+ breast cancer patients in France. The model focuses on administration costs and transportation costs that drive the difference of management between day hospitalization and home hospitalization. The costs are valued from a health insurance perspective. The costs of treatment administration were calculated from the current French tariff model and the National Cost Studies.

RESULTS: From a health insurance perspective, the average tariff of a day hospitalization administration, identified from the public and private hospital tariffs of the diagnosis-related group was €368.47. The average tariff of a home hospitalization administration, identified from the public and private hospital tariffs of the French model corresponding to 3 homogeneous groups of care, was €263.02 for day and home hospital treatment administration respectively. An additional €39.05 transportation cost was considered for hospital administration.

For a given patient, over a 5-year time horizon, with an average treatment duration of 14.4 months, a day hospital-based care management of €17,513 vs a home hospital-based care management of €12,406 were estimated, representing an individual average €5,107 saving (29.2%).

CONCLUSIONS: Home hospital-based care management of HER2+ breast cancer represents a promising cost-saving opportunity for healthcare insurance that could also relieve hospitals already overloaded in France.