Five-Year Healthcare Resource Consumption and Direct Costs of Women with a New Diagnosis of Hr+/HER2- Breast Cancer Primary or Advanced: Analysis of a Large Italian Administrative Database

OBJECTIVES: Assess the healthcare resource consumption and direct costs by the Italian National Health Service (INHS) for women newly diagnosed with HR+/HER2- breast cancer (BC), by absence/presence of lymphnode (LNM)/distant metastases (DM).

METHODS: From Fondazione Ricerca e Salute’s database (administrative data of ~5 million inhabitants/year), adult women with a new HR+/HER2- BC diagnosis in 2015 (index date) were categorized by absence (“primary”)/presence of in-hospital diagnoses of LNM/DM at index date or within the subsequent 60 days. Five-year overall (OS), distant relapse-free (DRFS) and invasive disease-free (IDFS) survivals (Kaplan Meyer analyses), and direct INHS costs were calculated. Among women with LNM, conservative/demolitive surgery and lymphadenectomy were assessed within one-year follow-up.

RESULTS: In 2015, of 2,603 women newly diagnosed with HR+/HER2- BC (incidence: 1.2x1,000 inhabitants), 2,019 had primary BC (mean age 62±14; 39% with ≥2 comorbidities), 420 LNM (60±14; 32%) and 164 DM (67±13; 46%). Within 1-year follow-up, 407/420 women with LNM underwent conservative/demolitive surgery, 170/420 also lymphadenectomy. In 5-year follow-up: OS and IDFS probabilities were 89% and 82% for women with primary BC, 88% and 79% with LNM, and 28% and 17% with DM, respectively (p<0.01); the DRFS probability of BC-women with LNM was 86%. The 1st follow-up year resulted the most expensive for the INHS: on average, each patient with primary BC, LNM and DM costed, respectively, € 9,190, € 11,421 and € 16,320 (hospitalizations, including the index one, accounted for 45.1%, 48.8% and 48.3%). The subsequent mean per capita annual expenditures diminished up to € 3,529, € 3,761 and € 7,166, respectively; hospitalization costs halved, while pharmaceuticals almost doubled, and outpatient specialist care slightly reduced for primary BC and LNM and increased for DM.

CONCLUSIONS: This study shows that HR+/HER2- BC-women diagnosed at advanced stages greatly impact on the INHS’s resource consumptions and direct costs.