OBJECTIVES: The economic burden of disease recurrence among patients with HR-EC is not well understood. This study quantified healthcare resource utilization (HRU) and healthcare costs by recurrence status in elderly patients with HR-EC receiving AT.

METHODS: Patients aged ≥66 years with newly-diagnosed HR-EC (stage I/II EC with non-endometroid histology or stage III/IVA EC with any histology) receiving hysterectomy and bilateral salpingo-oophorectomy followed by AT were identified in SEER-Medicare data (2007–2019). EC recurrence was defined using a claims-based algorithm developed with clinical input. All-cause and EC-related HRU (per-patient-year) and annual healthcare costs were estimated from EC recurrence (index date) for recurrent patients and from an imputed index date for those without recurrence (based on the distribution of index dates in recurrent patients) to mitigate immortal time bias. Statistical comparisons of HRU and costs between the two groups were conducted using Chi-square and Wilcoxon rank-sum tests, respectively.

RESULTS: Among 1,198 eligible patients (median age: 72.7; 71.3% stage I/II disease; 84.3% non-endometrioid carcinoma), radiation therapy, including chemoradiation (72.0%), and chemotherapy alone (25.7%) were the most common AT regimens. Disease recurrence occurred in 375 (31.3%) patients; median follow-up was 1.6 years for recurrent patients and 2.7 years for patients without recurrence. Recurrent patients had 2-fold higher rate of all-cause outpatient visits (38.18 vs. 22.18; p<0.001), 5-fold higher rate of EC-related visits (14.78 vs. 3.03; p<0.001), and 4-fold higher rate of all-cause hospitalizations (1.34 vs. 0.34; p<0.001) than patients without recurrence. Annual all-cause costs were $85,506 higher in recurrent patients (mean: $106,176 vs. $20,670; p<0.001), while EC-related costs were $62,511 higher (mean: $67,818 vs. $5,307; p<0.001), with these costs driven by hospitalizations.

CONCLUSIONS: Findings from this descriptive study suggest that a substantial economic burden is incurred by patients with recurrent HR-EC despite treatment with existing AT. Future multivariable research that adjusts for confounders can help validate the findings.