OBJECTIVES: aBC leads to significant direct and indirect costs. We performed a structured literature review to determine how various treatments affected economic burden in aBC.
METHODS: We searched publications indexed from January 1, 2013 to September 2, 2015 (PubMed, Embase, Cochrane Library) and meeting abstracts (AACR 2014-2015, ASCO 2014-2015, ASCO Breast Cancer Symposium 2014- 2015, and SABCS 2014). Eligible studies included women with hormone receptor– positive and human epidermal growth factor receptor 2–negative BC treated with chemotherapies and/or targeted therapies, including phosphatidylinositol 3 kinase inhibitors and cyclin-dependent kinase 4 and 6 inhibitors (particularly, fulvestrant, palbociclib, buparlisib, and everolimus). Only studies discussing economic burden were included.
RESULTS: The literature review identified 9 studies related to the economic burden of aBC. Direct and indirect economic costs attributable to aBC were substantial, and cost burden increased with disease stage. The majority of direct health expenditures associated with aBC were due to hospital services (inpatient and outpatient care) and pharmacy costs (eg, medications, nonprescription medications, and special equipment). Indirect costs have been recognized as an important component in evaluating the economic burden of aBC. Women with aBC experienced significantly higher productivity loss due to paid time off and short-term disability vs women with early-stage BC. Caregivers of women with aBC also had significant productivity loss. The main direct costs for late-stage BC were cytotoxic treatments and hormone therapy, and the main indirect cost was supportive care. Patients with aBC accrued a higher mean total cost burden compared with patients with early-stage BC. We also found that patients with later stages of disease consistently experienced higher total cost burden (US$47,000-$67,000 per person).
CONCLUSIONS: Patients with aBC had increased economic burden vs patients with milder forms of disease. Treatments that reduce risk of relapse and have a manageable safety profile may help reduce this burden.
