Costs of initial, continuing and terminal care in US patients with recurrence following early breast cancer

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Abstract
634 Background: Little is known regarding the economic impact of breast cancer (BC) recurrence on different phases of patient care (i.e. initial, continuing, and terminal). The objective of this study was to evaluate the economic impact of recurrence on different phases of care for such patients. Methods: A retrospective cohort study of 1616 patients (mean age 60 yrs) with early BC (stage I and II) was conducted using data from a large integrated health care system. Information on demographics, disease characteristics/treatment, charges for care, evidence/type of recurrence, and death was obtained. Phases of care were defined as initial care (6 months following diagnosis or recurrence), terminal care (6 months prior to death), and continuing care (period between initial and terminal phases of care). Tests were used for comparisons of charges between initial care after BC diagnosis and recurrence, continuing care (in quarterly estimates) pre- and post-recurrence, and terminal care between recurred and non-recurred patients. Charges were log-transformed and adjusted to 2003 US dollars. Results: During a median follow-up of 44.5 (range 6.1–98.3) months, there were 192 (11.9%) recurrence events (26.1% loco-regional, 15.6% contralateral, 58.3% distant) and 188 (11.6%) deaths due to any cause, of which 85 (5.3% of study population) were BC-related. For women experiencing recurrence of BC (n=74), the mean charges for care provided during the 6-month post-recurrence period were significantly higher compared with the initial 6-month period after BC diagnosis ($50,355 vs $38,254, p<.01). Quarterly charges for continuing care during the post-recurrence period were significantly higher than the pre-recurrence period ($4,934 vs $1,825, p<.001). Mean charges for terminal care were significantly higher (p<.01) for women experiencing a recurrence (n=27, $63,434) compared with non-recurred patients (n=65, $53,872). Conclusion: The study shows that BC recurrence among patients with early BC poses a significant economic burden during the entire continuum of care. Therapies shown to reduce the risk of BC recurrence may significantly reduce the costs of care of patients with early BC. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca AstraZeneca AstraZeneca

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