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TREATMENT PATTERNS AND OUTCOMES OF BREAST CANCER PATIENTS IN A PATIENT-CENTERED RETROSPECTIVE RESEARCH DATABASE Surasak Saokaew1,2, Beilei Cai1, Kuan-Ling Kuo1, Hillevi Bauer1, Frederick Albright1, Diana I. Brixner1,3, David Stenehjem1,4 1Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA, 2Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand, 3Program in Personalized Health Care, University of Utah, Salt Lake City, UT, USA University of Utah, 4Huntsman Cancer Institute, Salt Lake City, UT, USA. Results Background Although breast cancer is the most common cancer among American women, study investigating treatment pattern and costs is limited. This study aims to determine breast cancer treatment patterns and associated health care charges stratified by initial stage at diagnosis. Table 1 Study Population Baseline Characteristics Demographic Variable Stage I N=1310 N % Age (Mean, SD) Objective This retrospective study aims to determine breast cancer treatment patterns, charges, and overall survival stratified by initial stage at diagnosis Stage II N=1220 N % N =3109 Stage III N=425 N % Stage IV N=154 % All N=3109 N % N P-value 59.9 12.9 56.4 13.5 53.7 13.5 56.2 14.5 57.5 13.5 <0.001* 18-30 13 0.99 20 1.64 11 2.59 5 3.25 49 1.58 <0.001** 31-45 159 12.14 247 20.25 115 27.06 34 22.08 555 17.85 - 46-64 644 49.16 624 51.15 204 48.00 73 47.40 1545 49.69 - 65-79 404 30.84 256 20.98 78 18.35 33 21.43 771 24.80 - ≥80 90 6.87 73 5.98 17 4.00 9 5.84 189 6.08 - Caucasian/ White 856 65.34 824 67.54 285 67.06 96 62.34 2061 66.29 0.039** Asian American Indian/ Alaska native Native Hawaiian Black/African American Other 20 63 4.81 62 5.08 26 6.12 13 8.44 164 5.28 - Unknown 362 27.63 310 25.41 103 24.24 41 26.62 816 26.39 - 720 54.96 759 58.89 <0.001** Race Methods Data Source • • • University of Utah Health Sciences Enterprise Data Warehouse (EDW) and the Utah Population Database (UPDB) served as the primary data sources for this study All cancer cases across the University of Utah Healthcare (UUHC) and the Huntsman Cancer Institute (HCI) are integrated into the Enterprise Data Warehouse, which contains a comprehensive electronic medical record (EMR) for all patients Death certificate and cause of death information were provided by the UPDB. Patients were identified between these resources based upon a common master subject index unique for each patient Study Population • • • • Age ≥18 years on index date (01 Jan 1995 through 01 Jan 2011 ) At least 2 encounters in the EDW, with one encounter at least 30 days from index date Inclusion in the Huntsman Tumor Registry with ICDO site/histology codes suggestive of breast cancer Subjects must have informative stage data contained in the tumor registry Analysis • • • • • • Demographic characteristics of the patients were recorded on index date. Descriptive statistics, including mean, standard deviation, frequency and percentage as appropriate for continuous and categorical variables, were utilized to describe demographic characteristics. The Charlson Comorbidity Index (CCI) was used to assign a comorbidity score based on the ICD-9 codes. Tests of proportions were used to illustrate the differences in the demographic characteristics and other categorical variables. We used ANOVA to test multiple group difference for continuous and categorical variables, respectively First treatment in breast cancer patients was evaluated as first occurrence of surgery, radiation, or chemotherapy. We defined the time to first treatment as the number of days from the date of initial diagnosis to the date of first treatment Charge and medication data was only available from Jan 2002 to 31 Dec 2010, because there was inconsistent charge and medication data before 2002 in the EDW Survival function stratified by stage at diagnosis was assessed using Kaplan-Meier survival curve All statistical tests were performed at an a priori significance level of 0.05 using Stata SE v. 10 (StataCorp, College Station, TX) and SAS v. 9 (SAS Institute, Cary, NC) 1.53 7 0.57 4 0.94 1 0.65 32 1.03 - 4 0.31 7 0.57 4 0.94 0 0.00 15 0.48 - 2 0.15 6 0.49 1 0.24 3 1.95 12 0.39 - 3 0.23 4 0.33 2 0.47 0 0.00 9 0.29 - Plan Type Commercial 62.21 274 64.47 78 50.65 1831 Medicaid 35 2.67 50 4.10 23 5.41 18 11.69 126 4.05 - Medicare 425 32.44 289 23.69 88 20.71 37 24.03 839 26.99 - 69 5.27 71 5.82 16 3.76 9 5.84 165 5.31 Self pay and unfunded Other government 22 1.68 14 1.15 8 1.88 1 0.65 45 1.45 - Other/Unknown 39 2.98 37 3.03 16 3.76 11 7.14 103 3.31 - Utah 1104 84.3 1008 82.6 333 78.3 108 70.1 2553 82.1 Non-Utah Charlson Scores (Mean ± SD) 0 17.4 92 21.7 46 2.4 2.3 3.4 3.3 4.4 3.7 6.7 3.7 3.3 3.2 <0.001* 233 17.79 260 21.31 92 21.65 16 10.39 601 19.33 <0.001** 1 290 22.14 217 17.79 59 13.88 575 18.53 - 2 287 21.91 178 14.59 32 7.53 6 3.90 503 16.18 - >=3 500 38.17 565 46.31 242 56.94 122 79.22 1429 45.96 - - Region 206 15.7 212 10 29.9 556 6.49 <0.001** 17.9 - * ANOVA test, ** Chi square test Figure 3 Chemotherapy utilization at any time during survival (n = 207), 2002-2010 Results Figure 1 Flowchart of Patient Selection Unique Patients in the EDW Database 1995-2010 N=1,240,470 Age ≥18 Years Old N=965,460 Figure 4 Kaplan-Meier Survival Estimates by Stage at Diagnosis Kaplan-Meier survival estimates 1.00 Female Patients ≥18 years old N=495, 523 0.75 Female Patients with Diagnosis of Breast Cancer Using ICD-9 Codes N=8,139 0.50 Patients with Diagnosis of Breast Cancer Cross-linked with Tumor Registry N=3,999 0.25 Patients with Breast Cancer Staging Information N=3,497 0.00 Final Sample of Patients Limited to Breast Cancer Stages I, II, III, and IV N=3,109 0 Stage I N=1310 Stage II N=1220 Stage III N=425 1 2 3 4 Stage IV N=154 5 6 7 8 9 10 Follow up time (years) stage = 1 stage = 3 11 12 13 14 15 16 stage = 2 stage = 4 Figure 5 Annualized charges by stage and charge types Figure 2 Treatment received at anytime during survival (2002-2010) $80,000 $70,000 $5,680 $60,000 $50,000 $35,753 $40,000 $3,758 $30,000 $2,266 $20,000 $10,000 $1,489 $6,815 $0 $4,008 $2,339 Stage 1 (N=739) non-cancer inpatient $22,209 $11,799 $12,765 $4,230 $3,953 Stage 2 (N=666) non-cancer outpatient $5,848 $14,995 $6,362 Stage 3 (N=285) cancer-outpatient Stage 4 (N=93) cancer-inpatient Conclusions ISPOR 15th Annual European Congress, Berlin, Germany, November 3-7, 2012 This research was supported by an unrestricted research grant from Abbott Laboratories • Our findings suggest that the treatments and time to treatment in our cohorts are consistent with NCCN guidelines • Survival rates decreased by stage and were higher than National Cancer Data Base statistics • Health care charges increase by stage at diagnosis • These results provide unique information on the utilization and treatments in breast cancer towards the further conduct of oncology outcomes research