Work productivity among patients with metastatic breast cancer in the United States

OBJECTIVE

To characterize workplace productivity measures in patients with metastatic breast cancer (mBC) using line of therapy (LOT) and first line (1 L) regimen.

METHODS

A retrospective cohort study was conducted using IBM's MarketScan Commercial Claims and Encounters (CCAE) and Health and Productivity Management (HPM) databases. The cohort included patients diagnosed with mBC who initiated 1 L treatment between 2/3/2015 and 6/30/2018. Productivity was measured using days absent from work and short- and long-term disability (STD, LTD) claims by LOT and 1 L regimen (any cyclin-dependent kinase 4/6 inhibitor [CDK4/6i], endocrine monotherapy, chemotherapy only, or other anti-cancer therapy [OACT]). LOT was defined using regimen-based progression.

RESULTS

Overall, 548 patients were included; 148, 129, 145, and 126 received endocrine monotherapy, CDK4/6i, chemotherapy only, and OACT, respectively. The rate of LTD increased significantly by 3.1 and 2.6 times from 1 L to second line (2 L) and from 2 L to subsequent lines, respectively. Patients receiving 1 L chemotherapy had 2.4- and 2.7-times odds of using STD and LTD compared to patients receiving 1 L CDK4/6i.

CONCLUSIONS

Regimen-based disease progression is associated with increased use of STD and LTD. Patients with a 1 L regimen of chemotherapy have significantly higher odds of using STD or LTD than patients using 1 L CDK4/6i.

Economic burden of multiple myeloma among patients in successive lines of therapy in the United States

This study characterized the costs of multiple myeloma (MM) during first-line (1L), second-line (2L) and third-line (3L) treatment from the US payer perspective. Patients with ≥2 outpatient or ≥1 inpatient claims with a primary MM diagnosis and 12 months continuous enrollment post index were identified in a retrospective claims database between 1 July 2006 and 30 June 2013. A cost per-patient per-month (PPPM) metric was used to calculate total all-cause and anti-MM pharmacy costs in 1L, 2L, and 3L treatment. Of 5704 patients included, 3626 initiated 1L treatment, 1797 initiated 2L and 817 initiated 3L. Average total all-cause PPPM costs were $22,527 in 1L, $35,266 in 2L and $47,417 in 3L. Anti-MM pharmacy costs represented 22%, 29% and 29% of total all-cause costs PPPM in 1L, 2L and 3L, respectively. Study results suggest that delaying 2L and/or 3L treatment initiation may result in lower treatment costs for patients with MM.

The impact of self- and physician-administered cancer treatment on work productivity and healthcare utilization

BACKGROUND

Lost productivity in the workplace represents a significant portion of the economic burden of cancer in the United States. Cancer treatments have historically been physician-administered, while recent innovations have led to the development of self-administered, usually oral, agents. Self-administered treatments have the potential to reduce healthcare utilization and time away from work, but the magnitude of these effects is unknown.

OBJECTIVE

To compare the effects of self- and physician-administered cancer treatment on work productivity and health care utilization.

METHODS

Cancer subtypes with self- and physician-administered treatment options were selected. Patients with female breast, or lung or bronchus cancer diagnosed in 2004-2013 were identified in the Truven Health Analytics Commercial Claims and Encounters and Health and Productivity Management databases. Using multivariate regression models, work productivity and healthcare utilization were compared for patients receiving self- versus physician-administered treatment in the 12 months after initial diagnosis. Work productivity outcomes included the number of sick days and short-term disability claims.

RESULTS

One month of self- versus physician-administered treatment significantly reduced cancer-related outpatient services, doctor visits, and infusions in the 12 months after initial diagnosis for both cancers of interest. In addition, breast and lung or bronchus cancer patients who received self-administered treatment were less likely to have short-term disability claims, and breast cancer patients with non-metastatic disease who received self-administered treatment had significantly fewer sick days.

CONCLUSIONS

Self-administered cancer treatment was associated with fewer cancer-related outpatient services and reduced time away from work compared to physician-administered cancer treatment.

Abstract P1-11-07: The relationship between breast cancer progression and workplace productivity in the US

Background: A significant proportion of women with breast cancer leave employment due to their disease. Little is known about the effects of breast cancer progression on productivity among those who remain employed. We sought to determine the effect of disease progression on workplace productivity among women with breast cancer.

Methods: By linking health insurance claims data to workplace productivity data, a longitudinal dataset of women with breast cancer was constructed. The study cohort consisted of commercially insured women aged 18 to 64 in the US who were treated for any type of breast cancer between 2005 and 2012. Disease stage was measured through diagnosis codes and treatments observed, to classify women into the following breast cancer groups in each 90-day quarter: local; locally advanced; other non-metastatic; metastatic, 1st line therapy; metastatic, 2nd line therapy; metastatic, ≥ 3rd line therapy; metastatic, end-of-life care. Progression was defined as movement to a more advanced disease stage. Workplace productivity was measured as employment status and total hours away from work per quarter. Covariates included employer industry, comorbidities, age, region of residence, and a time trend. Reduced workplace productivity was valued using average U.S. wages by industry. Kaplan Meier analysis was used to test whether women whose cancer progressed were more likely to drop out of our employment-based sample. Linear and Heckman models were used to measure the effect of disease progression on workplace hours missed. The Heckman model was used to correct for selection bias, given that healthier women may be more likely to remain in our employment-based dataset.

Results: The study cohort included 6,409 women. Mean patient age was 52.0 years (SD: 7.7). The mean number of Charlson comorbidities was 0.52 per patient (SD: 2.9). The majority of our employment-based sample had non-metastatic breast cancer (90.7%). Breast cancer progression was associated with a lower probability of employment (hazard ratio = 0.65, P<0.01). Patients who left our employment-based dataset by the 12th quarter had a greater number of comorbidities (P<0.01) and missed a greater number of hours in the first two quarters (P<0.1), compared with those who remained. This indicated that patients leaving our employment-based sample were less healthy than those who stayed, supporting the use of the Heckman model. According to the Heckman results, progression was associated with increased workplace hours missed per quarter, both when comparing early versus late stage (P<0.001), and first-line versus later-line metastatic therapy (P<0.05). Linear results were similar. Using the Heckman results, the annual valuation of work missed per patient was $29,881 for patients without metastases and $34,141 for patients with, indicating that progression to metastatic cancer adds an additional $6,500 of lost work time, or about 14% of average US wages.

Conclusions: Breast cancer progression leads to increased workplace hours missed, with greater hours missed among those with more advanced disease. Avoiding or delaying disease progression could bring productivity gains to the workplace in addition to the benefits to the patient.

Support: This study was funded by Pfizer Inc.

Citation Format: Yin W, Horblyuk R, Perkins JJ, Sison S, Smith G, Snider JT, Wu Y, Philipson TJ. The relationship between breast cancer progression and workplace productivity in the US. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-11-07.

An accelerometry-based system for the assessment of balance and postural sway

The aim of this investigation was to develop an inexpensive, efficient system for the clinical assessment of static and dynamic balance and postural sway using accelerometry-based measurements. Subjects consisted of 10 young (range 18-32 years) and 10 older (range 69-86 years) individuals screened for polypharmacy and history of cardiovascular, neurological or orthopedic health conditions. A lightweight uniaxial accelerometer and general-purpose microcomputer were used to obtain measurements of postural sway. Customized software was written to acquire the data and provide a real-time display consisting of amplitude and frequency characteristics of the sway profile. Intraclass reliability coefficients greater than R = 0.75 were obtained in both eyes-open and challenging-standing balance tasks. Preliminary results demonstrate that the instrumentation can be used to discriminate among balance tasks and to differentiate healthy older adults from those with a tendency toward frequent falls. Moreover, the technique described yields a simple-to-administer, inexpensive procedure that can be conducted in the home or another natural environment. Accelerometry also allows for balance training and re-learning, using tasks that might ordinarily pose a balance challenge for the older or frail adult.