Healthcare Cost Patterns in CDK4/6 Inhibitor-Treated HR+/HER2- Metastatic Breast Cancer.

IF 3.1 3区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical Drug Investigation Pub Date : 2026-09-28 DOI:10.1007/s40261-026-01591-7

Munenobu Kashiwa, Kensuke Moriwaki

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引用次数: 0

Abstract

Background and objectives: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) are standard first-line treatment for hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer, yet the cost architecture across the full treatment trajectory remains poorly characterized. This study aimed to characterize phase-specific healthcare costs using a Japanese nationwide claims database.

Methods: We conducted a retrospective cohort study using the DeSC-IQVIA integrated Claims data (April 2014-May 2025). Patients with HR+/HER2- metastatic breast cancer who initiated first-line CDK4/6i were identified. Healthcare costs were decomposed into drug, non-drug inpatient, and non-drug outpatient components across eight treatment phases. Death-anchored analysis evaluated cost structure over the final 12 months of life among decedents.

Results: Among 5435 patients (median age 72.3 years), active treatment phases showed drug-dominated cost structures: first-line per-patient per-month (PPPM) cost was 482,936 Japanese yen (JPY) (drug 85%-90%), second-line 361,615 JPY (81%), and extended chemotherapy 255,922 JPY (66%). A marked inversion occurred in the palliative phase (PPPM 233,824 JPY; drug 11%, inpatient 70%) and terminal phase (PPPM 412,149 JPY; drug 17%, inpatient 69%). Death-anchored analysis of 1111 decedents identified a transition 2 months before death, when inpatient costs first exceeded drug costs. Individual fixed-effects models estimated the CDK4/6i-associated cost increment at 239,815 JPY/month (p < 0.001), corresponding to a total treatment-associated cost of 2.99 million JPY per patient.

Conclusions: The cost architecture of CDK4/6i-treated metastatic breast cancer follows a predictable trajectory from drug-dominated active treatment to hospitalization-dominated end-of-life care, with a structural transition approximately 2 months before death. These findings support phase-specific healthcare resource allocation and economic modeling.

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CDK4/6抑制剂治疗的HR+/HER2转移性乳腺癌的医疗费用模式

背景和目的：细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）是激素受体阳性、人表皮生长因子受体2阴性（HR+/HER2-）转移性乳腺癌的标准一线治疗方法，但整个治疗过程的成本结构仍不清楚。本研究旨在利用日本全国索赔数据库描述特定阶段的医疗保健费用。方法：采用DeSC-IQVIA综合索赔数据（2014年4月- 2025年5月）进行回顾性队列研究。HR+/HER2-转移性乳腺癌患者开始一线CDK4/6i鉴定。医疗保健费用在八个治疗阶段被分解为药物、非药物住院和非药物门诊部分。死亡锚定分析评估了死者生命最后12个月的成本结构。结果：5435例患者（中位年龄72.3岁）中，积极治疗阶段的成本结构以药物为主：一线每患者每月（PPPM）成本为482936日元（药物85%-90%），二线361615日元（81%），延长化疗255922日元（66%）。在缓和期（PPPM 233,824 JPY；药物11%，住院患者70%）和终末期（PPPM 412,149 JPY；药物17%，住院患者69%）发生了明显的逆转。对1111名死者的死亡锚定分析确定了死亡前2个月的过渡，当时住院费用首次超过药物费用。结论：cdk4 /6i治疗的转移性乳腺癌的成本结构遵循一个可预测的轨迹，从以药物为主的积极治疗到以住院为主的临终关怀，大约在死亡前2个月发生结构转变。这些发现支持特定阶段的医疗资源分配和经济建模。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Drug Investigation 医学-药学

CiteScore

5.90

自引率

3.10%

发文量

108

审稿时长

6-12 weeks

期刊介绍： Clinical Drug Investigation provides rapid publication of original research covering all phases of clinical drug development and therapeutic use of drugs. The Journal includes: -Clinical trials, outcomes research, clinical pharmacoeconomic studies and pharmacoepidemiology studies with a strong link to optimum prescribing practice for a drug or group of drugs. -Clinical pharmacodynamic and clinical pharmacokinetic studies with a strong link to clinical practice. -Pharmacodynamic and pharmacokinetic studies in healthy volunteers in which significant implications for clinical prescribing are discussed. -Studies focusing on the application of drug delivery technology in healthcare. -Short communications and case study reports that meet the above criteria will also be considered. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Clinical Drug Investigation may be accompanied by plain language summaries to assist readers who have some knowledge, but non in-depth expertise in, the area to understand important medical advances.