Economic Burden of HER2-Targeted Therapy Among Metastatic Breast Cancer Patients

There is limited information on the burden of metastatic breast cancer (MBC) with central nervous system (CNS) metastasis. The objective of the study presented at SABCS 2019 was to quantify the total all-cause healthcare resource utilization (HCRU) and costs among patients with MBC administered HER2-targeted therapy with/without CNS metastasis.1 This was a retrospective study comprised of continuously enrolled patients with a diagnosis of breast cancer and MBC (stage III/IV metastasis) and a pharmacy claim of anti-HER2 therapy identified from IQVIA’s Real-World Data: Adjudicated Claims-USA.

After excluding patients with breast-related surgery and radiation procedures in the 6-month baseline period, 3 treatment groups were created: trastuzumab (T) alone, T + chemotherapy (TC [including capecitabine or taxanes]), and a lapatinib group (L [with or without chemotherapy]), each further stratified by the presence/absence of CNS metastasis. All-cause HCRU and costs were evaluated over the 1-year follow-up period. A total of 5895 HER2-targeted therapy patients were initially identified, with 172 patients in each of the 3 treatment groups post-matching. Among these patients, 56.4%, 57.6%, and 59.3% of patients had a CNS metastasis in the T, TC, and L groups, respectively.

The baseline mean all-cause total costs were $77,069 among the T group (CNS, $83,164; no CNS, $69,186), $62,164 in the TC group (CNS, $66,906; no CNS, $55,733), and $81,007 in the L group (CNS, $95,803; no CNS, $59,447). Costs were mainly driven by pharmacy in the outpatient setting. Over the 1-year follow-up period, mean total pharmacy costs were $115,453, $81,091, and $119,319 among the T, TC, and L groups, respectively. This was followed by outpatient costs of $45,498, $62,263, and $69,654 in the T, TC, and L groups, respectively. Inpatient costs were $13,319 (average hospital length of stay [LOS], 2.9 days), $18,177 (LOS, 2.2 days), and $10,239 (LOS, 1.4 days) among the T, TC, and L groups, respectively. CNS patients had higher mean total costs compared with the no-CNS group among these treatment groups (T, $192,252 vs $153,784; TC, $237,376 vs $221,647; and L, $205,637 vs $191,219).

The authors concluded that costs among patients with MBC administered HER2-targeted therapy were highest for pharmacy, followed by outpatients and then inpatients over the 1-year follow-up period. Among each of the treatment groups, patients with CNS metastasis incurred higher costs compared with patients without a CNS metastasis.


1. Forero-Torres A, et al. SABCS 2019. Abstract P1-18-17.

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