OBJECTIVES: To review recent literature of the economic burden of patients who are disease-free and/or experiencing recurrence in HR+/HER2- early breast cancer.

METHODS: A systematic literature review of cost-effectiveness analyses (CEAs) and costing studies was conducted according to PRISMA guidelines. MEDLINE, Embase, and National Health Service Economic Evaluations databases were searched between January 2005 to July 2019. English-language articles evaluating direct/indirect costs, cost of illness, health resource utilization, caregiver burden, and productivity in stage I-III breast cancer were included. Screening and extraction of relevant details was performed by two independent reviewers.

RESULTS: A total of 4,544 records were screened. Of these, 32 studies published between 2008 and 2019 reported economic outcomes for HR+/HER2- early stage breast cancer patients (24 CEAs, 8 costing studies). No studies were identified which assessed the economic impact of endocrine or targeted therapies. Among CEAs, 12 studies (50%) included model inputs for the economic burden of disease-free status, local (4 studies, 17%) and/or distant (20 studies, 83%) recurrence. All of the included CEAs considered direct costs, while three considered both direct costs and the cost of absenteeism. No CEAs considered the impact of breast cancer on caregivers. None of the costing studies considered disease status (disease-free vs. recurrence) , and one reported both direct and indirect costs.

CONCLUSIONS: This systematic review indicates that contemporary economic evaluations of endocrine or targeted therapies for the treatment of early HR+/HER2- breast cancer are lacking, likely due to an absence of novel therapies for this population in recent years. Most studies focused on direct costs estimates with few providing indirect or broader patient and societal burden, such as caregiver burden and productivity. Further research is needed to articulate the full economic impact of HR+/HER2- breast cancer.