Treatment patterns among breast cancer patients in the United States using two national surveys on visits to physicians' offices and hospital outpatient departments

Social and economic burden of breast cancer in the North East region of Bulgaria

Introduction: Breast cancer is one of the most common malignancies among women and significantly worsens physical, mental and social functioning. The aim is to evaluate the social and economic burden of treatment strategies for breast cancer in the North East region of Bulgaria.Areas covered: A retrospective, observational, population-based study among patients with breast cancer was performed. Patient characteristics, treatment patterns, and costs were assessed during a four-year period (2016-2019). Disability-adjusted life years (DALYs) were calculated to estimate the social burden.Results: Approximately 99% of patients (n = 1,373) were female and the mean age at diagnosis was 60.6 years. The total economic burden of breast cancer during the time of the study was estimated to be 21,076,809.12 BGN where the direct costs were equal to 19,634,509.67 BGN and the total indirect costs due to premature death amounted to 1,442,299.45 BGN. Total DALYs were 110.56 for all patients corresponding to 1,898,340.80 BGN.Conclusions: This study demonstrates the significant social and economic burden of breast cancer as further, more comprehensive regional and national-based studies related to the total economic burden of breast cancer are required.

The Economic Burden Associated with the Management of Different Stages of Breast Cancer: A Retrospective Cost of Illness Analysis in Saudi Arabia

Globally, breast cancer management is associated with a heavy economic burden, but its impact in Saudi Arabia has not been fully quantified. The aim of this study was to estimate the economic burden of breast cancer management at various disease stages, in Saudi Arabia, from a payer perspective. We conducted a retrospective, multicenter cost of illness study in two governmental healthcare centers from January to December 2018, using the data of 300 patients at different breast cancer stages. A micro-costing, bottom-up method was used, and descriptive and inferential statistics were analyzed. The total estimated cost for treating breast cancer during the study period was $13.345 million USD, with the average cost per patient ranging from $14,249 USD in stage I to $81,489 USD in stage IV (p < 0.001). Medication cost was the main driver of total healthcare spending, followed by hospitalization and diagnostic tests. The cost of targeted therapy drugs represented 67% of the total medication costs, mostly driven by trastuzumab-based regimens. The economic burden of breast cancer management in Saudi Arabia is substantial and increases significantly with disease advancement. Early detection screening programs, evaluating the value of highly expensive interventions, and considering biosimilars, may contribute toward cost savings.

How the National Ambulatory Medical Care Survey has been used to identify health disparities in the care of patients in the United States

BACKGROUND

Healthcare disparities negatively impact patient health outcomes; addressing disparities could improve quality of life and decrease overall healthcare cost. The National Ambulatory Medical Care Survey (NAMCS) is an objective and reliable source for collecting information on United States (U.S.) ambulatory medical care service visits and may be a useful tool for identifying potential disparities in care.

OBJECTIVE

The purpose of this literature review is to describe studies utilizing NAMCS to capture U.S. healthcare disparities.

METHODS

PubMed was searched for scientific articles that utilized NAMCS to determine health disparities in the U.S. The keywords queried included "NAMCS" or "National Ambulatory Medical Care Survey" and "disparity" or "disparities" as a pair or additionally paired with one of the following: "race", "ethnicity", "age", "gender", "geography", or "insurance".

RESULTS

66 studies were found that incorporated NAMCS data from 1980-2016 into their methods to measure outcomes relating to health disparities. Disparities were found in the following categories: race/ethnicity, geographic location, age, insurance type, gender, specialist care versus primary care, body habitus, and preexisting conditions affecting patient outcomes. Disparities were identified in pain management, neurology, dermatology, psychiatry, patient communication access, and non-specialty specific or primary care visits related to disease conditions, screening, and treatment plans.

LIMITATIONS

Only PubMed was utilized as a search engine and may not encompass all studies on NAMCS and health disparities. NAMCS is a cross-sectional database and does not allow for longitudinal analyses.

CONCLUSIONS

NAMCS may be an underused tool given the limited number of articles that identify health disparities using it. Research studies utilizing NAMCS may identify potential disparities ultimately leading to better healthcare outcomes.

Direct medical costs of breast cancer in Jordan: cost drivers and predictors

Introduction: Breast cancer is the most common cancer amongst females in Jordan. The study aimed to estimate the total direct medical cost of breast cancer from a healthcare provider's perspective.Methods: A retrospective cohort study was done to include all Jordanian females who were diagnosed with breast cancer at two leading public providers of cancer care in Jordan, Bashir Hospital and the University of Jordan Hospital. Data were extracted from the Jordan Cancer Registry (JCR) from 2011 to 2014 including demographic, clinical, and economic data of the patient.Results: A total of 877 and 665 patients were included in the first and second year after diagnosis, respectively. Costs increased in the advanced stages; costs for stages 0, I, II, III, and IV were Jordanian dinars)JD(6,749.94 ($9,517.42), JD 5,960.46 ($8,404.25), JD 8,003.58 ($11,285.05), JD 9,390.59 ($13,240.73), and JD 9,587.44 ($13,518.29), respectively. Treatment costs were the main cost driver across all stages.Conclusions: This analysis offers insight into costs, cost drivers, and resources utilization incurred by breast cancer patients in Jordan. Two major hospitals in Jordan can play a key informative role in future cost-effectiveness of breast cancer screening and therapeutic treatments in the different stages of cancer.

Direct medical costs for stage-specific breast cancer: a retrospective analysis

Aim: To analyze the direct medical costs of breast cancer (BC) patients in the north of Jordan. Patients: A cohort of BC patients treated during 2015 at King Abdullah University Hospital. Methods: A retrospective analysis of 119 patients, where all records including age, sex, treatment processes and costs were extracted from the patients’ profiles and examined. Results: The mean age of patients was 50.8 (±10.2) years. The total sample cost was Jordanian dinar 1,393,325 (US$1,963,560). The mean cost per patient from stage I to IV was Jordanian dinar 6696, 9183, 11,970 and 15,073, respectively. Medications were the most expensive resource used. Stage IV had the highest cost and largest number of patients. Conclusion: Direct medical costs associated with BC are considerable. Three-quarters of the cost were devoted to medications.

Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study

Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I-III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life.

Global treatment costs of breast cancer by stage: A systematic review

Background

Published evidence on treatment costs of breast cancer varies widely in methodology and a global systematic review is lacking.

Objectives

This study aimed to conduct a systematic review to compare treatment costs of breast cancer by stage at diagnosis across countries at different levels of socio-economic development, and to identify key methodological differences in costing approaches.

Data sources

MEDLINE, EMBASE, and NHS Economic Evaluation Database (NHS EED) before April 2018.

Eligibility criteria

Studies were eligible if they reported treatment costs of breast cancer by stage at diagnosis using patient level data, in any language.

Study appraisal and synthesis methods

Study characteristics and treatment costs by stage were summarised. Study quality was assessed using the Drummond Checklist, and detailed methodological differences were further compared.

Results

Twenty studies were included, 15 from high-income countries and five from low- and middle-income countries. Eleven studies used the FIGO staging system, and the mean treatment costs of breast cancer at Stage II, III and IV were 32%, 95%, and 109% higher than Stage I. Five studies categorised stage as in situ, local, regional and distant. The mean treatment costs of regional and distant breast cancer were 41% and 165% higher than local breast cancer. Overall, the quality of studies ranged from 50% (lowest quality) to 84% (highest). Most studies used regression frameworks but the choice of regression model was rarely justified. Few studies described key methodological issues including skewness, zero values, censored data, missing data, and the inclusion of control groups to estimate disease-attributable costs.

Conclusions

Treatment costs of breast cancer generally increased with the advancement of the disease stage at diagnosis. Methodological issues should be better handled and properly described in future costing studies.