Breast Cancer Outcomes May Be Impacted by Treatment Setting

Trastuzumab-based therapies are recommended by the National Comprehensive Cancer Network for the treatment of HER2-positive (HER2+) metastatic breast cancer. In HER+ breast cancer patients, trastuzumab, administered via intravenous infusion, is indicated as both a single agent and as part of a treatment regimen with other chemotherapy. The optimum length of adjuvant therapy is generally accepted to be 1 year for patients with metastatic breast cancer; treatment with trastuzumab is generally recommended until disease progression.

Trastuzumab is administered in either an office clinic or outpatient hospital setting. It has been reported that the number of patients receiving treatment in an outpatient hospital setting has been increasing. Possible reasons for this shift in site of care include changes implemented in the Medicare Modernization Act (MMA) of 2003 in the reimbursement model for providers. The MMA decreased the amount of the reimbursement available to physicians for treatments covered by Part B, including oncology drugs.

Researchers recently conducted a retrospective cohort study to compare clinical and economic outcomes associated with hospital outpatient versus physician clinic site of care among patients with metastatic breast cancer. They reported study results during a poster session at the American Society of Clinical Oncology 2013 Annual Meeting. The poster was titled Comparison of Discontinuation, Healthcare Resource Utilization, and Costs between Patients with Metastatic Breast Cancer Who Received Trastuzumab in an Office Clinic versus Outpatient Hospital Setting.

The researchers utilized the US-based Humana Database (May 2007-April 2012) to identify patients who met inclusion and exclusion criteria. The final study cohort included 280 patients; 178 were treated in an office setting and 102 in an outpatient hospital setting.

The 2 groups were similar in terms of age and comorbidities, with the exception of chronic pulmonary disease (higher among patients in the outpatient hospital cohort) and iron deficiency anemia (higher among office clinic patients). In addition, more patients in the outpatient hospital setting cohort initiated trastuzumab in 2011 and were insured by Medicare plans compared with those in the office clinic group.

There was no statistically significant difference in terms of (1) observation period, (2) proportion of days on trastuzumab treatment, (3) trastuzumab treatment duration, and (4) proportion of patients who were treated at the end of the study period. A greater proportion of patients in the office clinic cohort were on a 7-day trastuzumab treatment schedule, whereas more patients in the outpatient hospital cohort were on a 21-day schedule.

Overall, following adjustment for confounding factors, there were no statistically significant differences observed in healthcare resource utilization between the 2 cohorts, with the exception of utilization of other medical services, where the incidence was higher in the office clinic cohort compared with the outpatient hospital group.

Total healthcare costs were statistically significantly lower for patients in the office clinic cohort, following adjustment for confounding factors (adjusted difference, $1954/month; P=.01). Total healthcare costs were driven primarily by medical costs; total costs excluding trastuzumab-related costs accounted for -60% of the total cost and no difference was found between the 2 cohorts in nontrastuzumab-related costs.

Patients treated in an office clinic setting incurred lower trastuzumab-related office and hospital costs compared with patients treated in an outpatient hospital setting ($3542 vs $4472; adjusted cost difference of $670; P<.04).