Advanced breast cancer treatment, hormonereceptor-positive with endocrine therapy versus chemotherapy: economic analysis in the Brazilian Public Healthcare System (BPHS)

Abstract

Objectives: To estimate the resource utilization and costs related to endocrine therapy (ET) versus chemotherapy (CT) in the treatment of hormone-receptor-positive (HR+) advanced breast cancer (ABC) patients after at least one previous ET. Methods: This retrospective longitudinal study analyzed ABC patients treatment with fulvestrant or CT from 2006 to 2008 in a public oncology outpatient service. Only patients without visceral crisis and with no less than one previous hormonal therapy were considered eligible. Medical charts were reviewed by two investigators and information about diagnosis, course of treatment, and resource utilization was obtained. Results: Patients were all female and the mean age was 64,6 ± 12,6 years. Patients were well-matched between groups considering baseline characteristics. Twenty-five patients were enrolled in the study, 13 patients received CT and 12 patients received fulvestrant. The most common CT regimen was paclitaxel (n = 5, 38%). The mean number of cycles was 7,6 and 5,8 for fulvestrant and CT, respectively. The mean treatment cost per patient was BRL 16,679 (USD11,914; 2005 purchasing power parity index 1USD = 1.4BRL) for fulvestrant and BRL32,946 (USD23,533) for CT. The avarage cost per cycle was BRL 2,199 (USD1,571) and BRL5,710 (USD4,079) for fulvestrant and CT, respectively, resulting in BRL3,511 (USD2,508) incremental cost per cycle. Conclusions: Our study results indicate that subsequent ET with fulvestrant can be economically appropriate among HR+ ABC patients. Further researches could validate these findings in other contexts, however we consider that our estimations reflect the real-world clinical practice in Brazil.