Utilização de cuidados de saúde e custos do cancro da mama precoce

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Utilização de cuidados de saúde e custos do cancro da mama precoce

Quinta, 01.04.2021

O cancro da mama é uma doença heterogénea, composta por diferentes subtipos. No entanto, não existem dados do mundo real sobre o custo do tratamento de acordo com estes diferentes subtipos. Este estudo teve como objetivo estimar os custos médicos diretos do diagnóstico e tratamento do cancro da mama precoce nos primeiros 3 anos após o diagnóstico, de acordo com o subtipo e o estádio.

Foram incluídas 703 mulheres com cancro da mama precoce, recém-diagnosticado, admitidas em 2012 no Instituto Português de Oncologia do Porto, que foram acompanhadas prospetivamente na coorte NEON-BC.

A maioria das doentes apresentava o subtipo recetor hormonal positivo/HER2−negativo (cerca de três quartos), seguidos do HER2-positivo (16%) e do triplo-negativo (8%). Verificamos que o custo mediano do tratamento foi de €10 540 / doente no subtipo recetor hormonal positivo/HER2−negativo, €11 224/ doente no triplo-negativo e quatro vezes maior entre as doentes com tumores HER2-positivo (€41 513 / doente).

Esses resultados fornecem informações para a avaliação económica de tratamentos inovadores para o cancro da mama em estádio inicial e destacam o peso que a terapia sistémica-alvo (isto é, dirigida às características moleculares do tumor) pode ter no custo geral do tratamento entre as doentes com cancro da mama precoce.

 

Autores e Afiliações:

Mariana Brandãoa,b,c, Samantha Moraisa,d, Luísa Lopes-Conceiçãoa, Filipa Fontesa,b,d, Natália Araújoa, Teresa Diasb, Deolinda Pereirab, Marina Borgesb,e, Susana Pereiraa,b, Nuno Luneta,d

a EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091 Porto, Portugal

b Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal

c Institut Jules Bordet, Boulevard de Waterloo 121, 1000 Brussels, Belgium

d Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal

e Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Av. Padre Cruz, 1600-560 Lisboa, Portugal

 

Abstract:

Background: The cost of breast cancer care rises with higher stage at diagnosis; however, there are no real-world data regarding the cost of care according to breast cancer subtypes. This study aimed to estimate direct medical costs for early breast cancer care in the first 3 years after diagnosis according to subtype and stage, using patient-level data.

Methods: Women with newly diagnosed stage I–III breast cancer, admitted in 2012 to a Portuguese cancer centre were prospectively followed within the NEON-BC cohort. The use of health resources was obtained from each patient’s clinical and administrative records and costs were computed. Tumours were classified into the classic subtypes (hormone receptor-positive (HR+)/HER2−; HER2-positive (HER2+); triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (luminal A-like; luminal B-like; HER2 enriched; basal like).

Results: A total of 703 patients were included: 48.9% had stage I, 35.8% stage II and 15.2% stage III breast cancer; 76.4% had HR+/HER2−, 15.9% HER2+ and 7.7% TNBC. Median cost of care was €9215/patient in stage I, €13 019/patient in stage II and €15 011/patient in stage III and €10 540/patient in HR+/HER2−, €11 224/patient in TNBC and €41 513/patient in HER2+ breast cancer. Systemic therapy accounted for 69.2% of the cost of care among patients with HER2+, 12.0% among HR+/HER2− and 7.5% among TNBC patients. Similar differences were observed across surrogate intrinsic subtypes.

Conclusions: The cost of early breast cancer care was mainly driven by the tumour subtype and, to a lesser extent, by stage. The median cost of care was fourfold higher among patients with HER2+ tumours compared with those with HR+/HER2− and TNBC. These data provide information for the economic evaluation of innovative treatments for early breast cancer and highlight the weight that targeted systemic therapy might have in the overall cost of care among patients with early breast cancer.

 

Revista: ESMO Open

 

Link:  https://www.esmoopen.com/article/S2059-7029(20)32749-6/fulltext