Burden of Early-Stage Triple-Negative Breast Cancer in a US Managed Care Plan

Abstract

Objective

Triple-negative breast cancer (TNBC) is a high-grade breast cancer with an aggressive clinical course. We examined the recurrence rate, health care utilization, and cost of early-stage TNBC in the US managed care setting.

Study Design

A retrospective study using linked cancer registry, health care claims, and social administration databases.

Methods

This retrospective study used the Impact Intelligence Oncology Management cancer registry, linked to 1999-2009 administrative claims, from a national managed care health plan and also Social Security Administration mortality data. Patients with stage I-III TNBC and non-TNBC were followed from diagnosis to recurrence, disenrollment, or end of observation period. Risk-adjusted recurrence rate, health care utilization, and costs during the follow-up period were compared.

Results

A total of 1967 women (403 with TNBC) were included; 289 (14.7%) had local/distant recurrence during the follow-up period. Patients with TNBC were younger (53.68 vs. 56.16 years, P < .0001) and more likely to experience recurrence compared with non-TNBC (21.6% vs. 12.9%, P < .0001; adjusted hazard ratio = 2.11, P < .0001). In terms of adjusted annual health care utilization and costs, patients with TNBC had significantly higher numbers of hospitalizations (1.20 vs. 0.90, P = .001); hospitalization days (8.80 vs. 4.97, P < .0001); and emergency department (ED) visits (1.45 vs. 0.95, P = .009). They also had significantly higher inpatient costs (all-cause: $9154 vs. $5501; cancer-related: $5632 vs. $2869; P < .0001 for both); and ED costs (all-cause: $303 vs. $182, P = .003; cancer-related: $240 vs. $138, P = .012).

Conclusions

This study demonstrates that, compared with non-TNBC, early-stage TNBC is associated with higher rate of recurrence, resulting in increased health care utilization and costs.