1371P_PR - Venous Thromboembolism (VTE) in breast and prostate cancer patients receiving chemotherapy – a US real world analysis of risk and economic burden.

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Complications of Treatment
Bioethics, Legal, and Economic Issues
Breast Cancer
Prostate Cancer
Presenter Nicole Kuderer
Authors N.M. Kuderer1, H. Wang2, J. Mehta3, L. Eckert4, A. Hamed3
  • 1Duke University School of Medicine, 27705 - Durham/US
  • 2Evidence And Value Development, Sanofi, 08807 - Bridgewater/US
  • 3Evidence And Value Development, Sanofi Aventis, 02142 - Cambridge/US
  • 4Evidence And Value Development, Sanofi, 91385 - Chilly-Mazarin/FR

Abstract


Background: Breast and prostate cancer represent the top cancers among women and men, respectively in US. These patients are at an increased risk of VTE, and chemotherapy is an additional risk factor. Rates of VTE vary by cancer type, stage and time from chemotherapy initiation. This study explores rates of VTE after chemotherapy.

Methods: The US IMPACT® claims database was used to retrospectively identify patients with breast and prostate cancer initiating chemotherapy between 1/1/05 and 12/31/08. Index date was defined as the first day of chemotherapy after cancer diagnosis. Patients with = 12 months of continuous medical coverage prior to index date and = 3.5 months during follow-up were included. Patients with prior VTE within 12 months, major bleeding within 3 months, or anticoagulant treatment within 2 weeks of index date were excluded. Baseline characteristics and health care costs (pharmacy, inpatient, emergency room, and outpatient costs) were assessed at 1 year pre index. Incidence of VTE was assessed at 3.5 and 12 months post index and costs at 1 year post index.

Results: 34,144 patients were identified. Both groups had comparable demographic distribution. Risk of VTE 3.5 months after chemotherapy initiation was 3.9% for breast cancer and 3.6% for prostate cancer patients. Prostate cancer patients who developed VTE within 12 months post index had comparable healthcare costs at baseline ($29,373) to those without VTE ($24,595). However, during 1 year post index, costs in VTE patients were significantly higher ($80,583) than in those without VTE ($39,102) driven by inpatient and outpatient costs. Similar pattern was observed for breast cancer patients. The table below shows baseline characteristics, costs and VTE risk in patients.

Baseline Characteristics

Prostate (n=7,379)

Breast (n=26,765)

VTE

12 months

No VTE

12 months

VTE

12 months

No VTE

12 months

Mean Age (years)

71.2

70.2

58.2

56.4

Charlson Comorbidity Index

6.3

5.0

6.3

5.4

Annual Costs ($)

Baseline

29,373

24,595

35,994

30,893

Follow-Up

80,583

39,102

109,825

73,827

VTE risk (% ) 3.5 months

3.6

3.9

VTE risk (%) 12 months

8.1

7.1

Conclusions: Risk of VTE 3.5 months after chemo initiation is about 4% for two major cancer types and almost doubles at 12 months. VTE is also associated with significant economic burden. Further economic studies are needed to assess cost-effectiveness and cost-utility of thromboprophylaxis in these tumor sites.