An Analysis of Treatment Patterns and Outcomes in Patients with Triple Negative Breast Cancer

A recent study has found that duration and cost both increase as treatment lines progress in patients with metastatic triple negative breast cancer (TNBC). These study results were presented at AMCP Nexus 2019, and the research was also selected by the society as a Best Poster Abstract.

The researchers leveraged an oncology clinical data program integrated with claims data to describe treatment patterns and outcomes. The integration of clinical and claims data allows researchers to examine outcomes and characteristics that are not usually available in an individual database and is necessary for creating real-world evidence. The goal of using this data program was to evaluate treatment patterns, resource utilization, and total costs among TNBC patients.

Patients included in this study were those with metastatic TNBC diagnosed from February 2016 to May 2018 onwards with both clinical information from a Prior Authorization (PA) tool, based on NCCN guidelines, and claims from the Optum Research Database. Demographic data, treatment duration, resource utilization, total cost, and clinical information (such as HER2 status, hormone status, metastatic status, and treatment line) were collected and uploaded to a dynamic web-based Tableau® dashboard. Cost data were all adjusted to represent 2017 values.

The researchers identified 357 TNBC patients were identified, with 213 (60%) of them being in their first line of therapy and 48% being at least 55 years of age. The top five observed first line regimens, cyclophosphamide + doxorubicin, carboplatin/cisplatin + gemcitabine, paclitaxel, paclitaxel protein-bound, and carboplatin/cisplatin + paclitaxel, accounted for 76% of patients (accounting for 25%, 24%, 14%, 8%, and 5%, respectively.

The average first-line therapy duration was 76.2 days (median: 57 days) with 80% of all patients having non-censored first lines. 41 patients (19%) had at least one inpatient stay during their first line. The average total cost of first line therapy was $50,087 (SD: $56,111).

A total of 144 patients were in line 2+ at the first encounter in the PA data, with the top three most common non-first line treatment therapies accounting for 49% of all episodes [carboplatin/cisplatin + gemcitabine (19%), eribulin mesylate (18%), and paclitaxel protein-bound (12%)]. Average 2+ line therapy duration was found to be 91.1 days with 118 (82%) being non-censored. 37 (26%) patients had 1+ inpatient stay during the line, and the average total cost of non-first line therapy was $56,310 (SD: $62,768).

As the treatment lines progress, duration and costs increase by 20% and 12% respectively,” the study authors concluded. “Combination of clinical and claims based data points are valuable to evaluate treatment outcomes in specific personalized sub cohorts of patients and maybe one day used for treatment selection at individual lines of therapy.”

 

Meeting Abstract:

Chastek, B, Lal, L, et al. Evaluation of Treatment Patterns and Outcomes from Linked Claims plus Clinical Prior Authorization Data in Patients Diagnosed with Triple Negative Breast Cancer (TNBC). Presented at: AMCP Nexus 2019; October 29 – Nov 1; National Harbor, MD.