Costs of metastatic breast cancer could jump 140% by 2030
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Total annual costs associated with metastatic breast cancer in the U.S. could exceed $152 billion in 2030, according to a study published in JNCI Cancer Spectrum.
Researchers attributed the estimated increase to a rise in cases among younger women.
“My colleagues at the CDC and I had been investigating the economic burden of breast cancer for younger women. CDC was interested in focusing on younger women with metastatic breast cancer, given the growth in this population and the high disease burden for these women,” Justin Trogdon, PhD, research fellow at the Center for Health Promotion and Disease Prevention at The University of North Carolina at Chapel Hill and professor of health policy and management at the UNC Gillings School of Global Public Health, told Healio. “This is one of the first studies to look at trends in prevalence and cost of metastatic breast cancer by age group.”
Trogdon and colleagues developed a stock/flow model of women entering the metastatic breast cancer population at initial diagnosis or through progression of earlier-stage cancer and exiting through death.
Researchers estimated the number of metastatic breast cancer cases and costs attributable to metastatic breast cancer from 2015 through 2030 among three different age groups — younger (aged 18 to 44 years), midlife (aged 45 to 64 years) and older (aged 65 years and older). They used U.S. Census projections and data from the SEER registry and peer-reviewed literature for input parameters by age and phase of treatment.
Results showed an estimated increase in metastatic breast cancer cases of 54.8%, from 158,997 in 2015 to 246,194 in 2030. Estimated medical and productivity costs of metastatic breast cancer in 2015 across all age groups and phases of care totaled $63.4 billion (95% sensitivity range, 59.4 billion to 67.4 billion), which researchers estimated would jump by 140% to $152.4 billion in 2030.
Estimated total costs in 2030 were highest for women aged 45 to 64 years ($75.3 billion) followed by women aged 18 to 44 years ($42.4 billion) and women aged 65 years and older ($34.7 billion).
“Our results suggest that the cost of metastatic breast cancer could increase substantially in the coming decade, especially among younger and midlife women,” Trogdon said. “We have one more analysis forthcoming that investigates the cost effectiveness of different treatment options for metastatic breast cancer.”
For more information:
Justin Trogdon, PhD, can be reached at The University of North Carolina at Chapel Hill, 250 E. Franklin St., Chapel Hill, NC 27514; email: justintrogdon@unc.edu.
Perspective
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Despite advances in every subset of breast cancer that resulted in tangible improvements in OS in the metastatic setting, deaths from metastases continue to occur.
The data from this study by Gogate and colleagues highlight the increasing prevalence of metastatic breast cancer deaths and increasing costs of caring for these women expected in 2030.
The numbers are staggering. As expected, costs for younger and middle-aged women are projected to be higher than those for the eldest women.
Despite the limitations and potential inaccuracies of modeling performed in a single state — which the authors acknowledge — more deaths and higher costs are to come.
What can be done about it? Important strategies include improving breast imaging techniques that diagnose breast cancers when they are more curable; mounting trials in the prevention setting, such as using olaparib (Lynparza; AstraZeneca, Merck) for germline carriers of BRCA1 and BRCA2 mutations; and using early biomarkers — such as circulating DNA — to assess resistant disease so those who are not responding do not continue to receive ineffective treatment. Circulating DNA also can be used to identify targetable mutations.
Continued studies on treatment de-escalation will lead to lower costs and less morbidity. We over-test hospitalized patients — for example, administering daily blood tests or performing expensive imaging when plain films will do. Finally, earlier discussions about goals of care are essential so high utilization of the ICU and chemotherapy does not occur in the last 6 weeks of life.
There are many other examples of cost savings in treating metastatic breast cancer. Slow but steady incremental progress in therapeutics for metastatic breast cancer, advances in breast imaging and cost savings that are readily implementable will continue during the next decade.
Hopefully, these efforts will decrease the societal burdens of metastatic breast cancer in terms of mortality and costs.
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