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Research article
Estimation of Healthcare-related Charges in Women with BRCA Mutations and Breast Cancer
Joseph Biskupiak
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9436-0984
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Breast cancer costs were estimated at $16.5 billion in 2010 and were higher than other cancer costs. There are limited studies on breast cancer charges and costs by BRCA mutations and receptor status. We examined overall health care and breast cancer-related charges by BRCA status (BRCAm vs. BRCAwt), receptor status (HER2+ vs. HER2-), and treatment setting (neoadjuvant vs. adjuvant).
Methods
Retrospective cohort study of charge data from 1995-2014 in an academic medical center. Facilities, physician, pharmacy, and diagnosis-related charges were presented as mean and median charges with standard deviation (SD) and interquartile ranges (25%-75%). Wilcoxon rank-sum test was used to assess statistically significant differences in charges between comparators.
Results
Total median breast-cancer related charges were $65,414 for BRCAm and $54,635 for BRCAwt (p=0.19); however all-cause charges were higher for BRCAm patients ($145,066 vs. $119,119, p<0.001). HER2+ status was associated with higher median breast cancer charges ($152,159 vs. $44,087, p<0.0001) that was driven by the charges for biological agents. Patients initially seen in the neoadjuvant setting had higher mean breast cancer charges than in the adjuvant setting ($117,922 vs. $80,061, p<0.0001).
Conclusion
BRCA mutation status was not associated with higher breast cancer charges but HER2+ status had significantly higher charges, due to charges for biological agents. Patients who initially received neoadjuvant treatment had significantly higher overall treatment charges than adjuvant therapy patients. With the advent of novel therapies for BRCAm, the economic impact of these treatments will be important to consider relative to their survival benefits.
Keywords
Breast cancer, BRCA, HER-2, charges
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CURRENT STATUS: Under Review
Version 2
Posted 07 Jan, 2021
No community comments so far
Submission checks complete
On 24 Dec, 2020
Editorial decision: Minor revision
On 16 Dec, 2020
Editor assigned
On 15 Dec, 2020
Submission checks complete
On 15 Dec, 2020
Editor invited
On 15 Dec, 2020
No comments provided
Editorial decision: Major revision
On 08 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Review #2 received
Received 28 Sep, 2020
Reviewer #3 agreed
On 21 Sep, 2020
Reviewer #2 agreed
On 16 Sep, 2020
Reviewer #1 agreed
On 26 Aug, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
Editor assigned
On 16 Jul, 2020
First submitted
On 15 Jul, 2020
Submission checks complete
On 15 Jul, 2020
Editor invited
On 15 Jul, 2020
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This preprint is under consideration at BMC Health Services Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Estimation of Healthcare-related Charges in Women with BRCA Mutations and Breast Cancer
Joseph Biskupiak
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9436-0984
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 07 Jan, 2021
No community comments so far
Submission checks complete
On 24 Dec, 2020
Editorial decision: Minor revision
On 16 Dec, 2020
Editor assigned
On 15 Dec, 2020
Submission checks complete
On 15 Dec, 2020
Editor invited
On 15 Dec, 2020
No comments provided
Editorial decision: Major revision
On 08 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Review #2 received
Received 28 Sep, 2020
Reviewer #3 agreed
On 21 Sep, 2020
Reviewer #2 agreed
On 16 Sep, 2020
Reviewer #1 agreed
On 26 Aug, 2020
Reviewers invited
Invitations sent on 28 Jul, 2020
Editor assigned
On 16 Jul, 2020
First submitted
On 15 Jul, 2020
Submission checks complete
On 15 Jul, 2020
Editor invited
On 15 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Breast cancer costs were estimated at $16.5 billion in 2010 and were higher than other cancer costs. There are limited studies on breast cancer charges and costs by BRCA mutations and receptor status. We examined overall health care and breast cancer-related charges by BRCA status (BRCAm vs. BRCAwt), receptor status (HER2+ vs. HER2-), and treatment setting (neoadjuvant vs. adjuvant).
Methods
Retrospective cohort study of charge data from 1995-2014 in an academic medical center. Facilities, physician, pharmacy, and diagnosis-related charges were presented as mean and median charges with standard deviation (SD) and interquartile ranges (25%-75%). Wilcoxon rank-sum test was used to assess statistically significant differences in charges between comparators.
Results
Total median breast-cancer related charges were $65,414 for BRCAm and $54,635 for BRCAwt (p=0.19); however all-cause charges were higher for BRCAm patients ($145,066 vs. $119,119, p<0.001). HER2+ status was associated with higher median breast cancer charges ($152,159 vs. $44,087, p<0.0001) that was driven by the charges for biological agents. Patients initially seen in the neoadjuvant setting had higher mean breast cancer charges than in the adjuvant setting ($117,922 vs. $80,061, p<0.0001).
Conclusion
BRCA mutation status was not associated with higher breast cancer charges but HER2+ status had significantly higher charges, due to charges for biological agents. Patients who initially received neoadjuvant treatment had significantly higher overall treatment charges than adjuvant therapy patients. With the advent of novel therapies for BRCAm, the economic impact of these treatments will be important to consider relative to their survival benefits.
Figure 1
Figure 2
Figure 3
Figure 4