Cost and Prevalence of Metastatic Breast Cancer Expected to Rise Through 2030

Costs associated with metastatic breast cancer are expected to rise substantially through 2030, especially among younger and midlife women, according to research published in the JNCI Cancer Spectrum.

In 2015, the total cost of care across all age groups and phases of care was $63.4 billion (95% sensitivity range [SR], $59.4-$67.4 billion). Projections suggested that the costs could increase by 140% to $152.4 billion (95% SR, $111.6-$220.4 billion) in 2030.

“The results of this study highlight groups of [patients with metastatic breast cancer] by age that may require support to mitigate the adverse economic consequences from medical and productivity costs associated with the disease,” the investigators wrote. “The projections also provide a useful baseline against which to measure the effect of current and future efforts to reduce the burden to patients and families.”

A stock and flow model was developed to project the population and costs of metastatic breast cancer over time. Women with stage IV disease at initial diagnosis or women with early-stage breast cancer that can progress to metastatic disease were included in the population. Initial metastatic cases, continuing metastatic cases, and terminal metastatic cases were all estimated in this research.

Cost estimates incorporated data from the 2003 to 2014 North Carolina cancer registry. Costs for inpatient, outpatient, physician visits, and prescriptions were components incorporated into total direct medical costs. The initial phase included costs 12 months after diagnosis, the terminal phase focused on costs associated with the final 12 months of life, and the continuing phase focused on the time in between. Medical costs are estimated to increase by 5% annually between 2015 and 2030.

The 2030 estimates suggest 246,194 prevalent cases of metastatic breast cancer will occur, which represents a 54.8% increase from the estimated 158,997 prevalent cases reported in 2015. The base model estimates for 2030 indicate that 48,203 prevalent cases of metastatic breast cancer will take place in patients aged 18 to 44 years, 120,916 cases will be in patients aged 45 and 64 years, and 77,075 (31.3%) will be in patients aged 65 years or older.

In terms of cost, 2030 estimates found that women between the ages of 45 to 64 years will represent the highest total costs at $75.3 billion (95% SR, $55.1-$108.9 billion) with costs for women aged 18 to 44 years ($42.4 billion; 95% SR, $31.9-$60.8 billion) and women aged 65 years or older ($34.7 billion; 95% SR, $24.0-$52.4 billion) following.

The study is limited by its unfamiliarity with population-level data on the trends in progression rates from early to metastatic breast cancer. Further, the medical cost estimates gathered from North Carolina might not be generalizable to the entire United States. Lastly, the study was unable to calculate confidence intervals, using sensitivity analyses as a replacement.

“We did not attempt to forecast structural changes such as technological innovations in breast cancer treatment and health-care delivery reforms in these inputs. However, these changes could dramatically alter the future of metastatic breast cancer cases and costs,” the investigators concluded.

Reference

Gogate A, Wheeler SB, Reeder-Hayes KE, et al. Projecting the prevalence and costs of metastatic breast cancer from 2015 through 2030. JNCI Cancer Spectr. 2021;5(4):pkab063. doi:10.1093/jncics/pkab063