Breast Cancer a Health Economic Overview

Transcription

1 Swiss Academy of Multidisciplinary Oncology Breast Cancer a Health Economic Overview Prof. Dr. Thomas D. Szucs Chairman of the Board, Helsana Versicherungen AG Professor of Medicine, Universität Basel

2 Introduction Burden of Disease Economic Burden Burden Containment Concluding Remarks 2

3 Breast Cancer Burden of Disease "ONE IN EVERY EIGHT WOMEN WILL GET BREAST CANCER IN THEIR LIFETIME." WHEW! THAT WAS CLOSE! 3

4 Rate per 100'000 Population Incidence Rates for Selected Cancers USA from 1975 to 2009 Men Women Prostate Breast Lung & Bronchus Colorectum Colorectum Lung & Bronchus Urinary Bladder Urinary Bladder Melanoma of the Skin Thyroid Liver Melanoma of the Skin Thyroid Liver Year of Diagnosis Year of Diagnosis Siegel, R., Cancer Statistics,

5 Cancer Incidence per Country Men Globocan 2008, (IARC) Section of Cancer Information 5

6 Cancer Incidence per Country Women Globocan 2008, (IARC) Section of Cancer Information 6

7 Increase in Breast Cancer Incidence Developing Countries Aside from population growth, breast cancer incidence rates are expected to further increase within many less developed countries due to: longer life expectancy coupled with the adoption of a more westernized lifestyle involving higher levels of alcohol consumption less physical activity delays in childbearing As a consequence, the worldwide breast cancer burden is likely to be heavily influenced by changes to incidence in the Asia region, particularly China and India Youlden D.R. et al., The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality,

8 Increase & Decrease in Breast Cancer Incidence Developed World Introduction of mammography (Giles 2003, Nasseri 2004) Increasing prevalence of risk factors obesity, early age at puberty, alcohol consumption, reduced physical activity and having childredn at older age, if any (Hortobagyi 2005, Parkin 2006, Shin 2010) Reduction in the use of hormone replacement therapy (Kumle 2008, Verkooijen 2009) Plateau in participation rates for mammographic screening (Saika 2011, Breen 2011) A decline in the pool of cases that were diagnosed by screening prior to becoming symptomatic (MacMahon 2008) 8

9 Worldwide Breast Cancer Incidence versus Mortality Switzerland 1. vs. 18. Incidence: Cancer Indicence in Five Continents, VOL IX. Mortality: WHO Mortality Database 9

10 Breat Cancer Mortality Increase, Stagnation and Decrease years Canada United States * * * * * * * * * * Ukraine Israel Kazakhstan Russian Federation South Korea Japan Hong Kong Singpore Australia * Denmark, France, Germany, Hungary, Ireland, Italy, the Netherlands, Poland, Romania, Spain, Sweden, the United Kingdom Youlden D.R. et al., The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality,

11 Breast Cancer Case Mortality Rates (%), % Low Income Lower Middle Income Upper Middle Income High Income 10 0 Low Income Lower Middle Income Upper Middle Income High Income 11

12 Rate per 100'000 Population Cancer Mortality Rates Deaths Averted Between 1991/ Men Women Expected rate Expected rate Real rate 833'300 Cancer Deaths Averted 344'000 Cancer Deaths Averted Real rate Year of Diagnosis Year of Diagnosis Siegel, R., Cancer Statistics,

13 Decrease of Breast Cancer Mortality Significant Improvements in Treating Cancer Patients The gains achieved in the treatment of breast cancer over the previous years continue better tailoring therapies to individual patients through molecular profiling Improved understanding of breast cancer types that are not amenable to either hormonal therapy or therapies that target HER2 receptors ( triple-negative breast cancer), New insights into management and treatment options for women "triplenegative" cancer Youlden D.R. et al., The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality,

14 Economic Burden Burden of Disease Economic Burden Burden Containment Concluding Remarks 14

15 Total Costs of New Breast Cancer Cases by Geographic Region in 2009 ($m) Americas US$17,221 Europe US$ 8,742 Africa US$76 Asia US$1,928 Oceania US$461 David Bloom, Harvard School of Public Health, November 4, 2009, Breast cancer in the developing world: meeting the unforeseen challenge to women, health and equity 15

16 Breast Cancer Costs in European Comparison Within Europe cancers costs 124 billion Euros each year Germany highest rate Lithuania lowest rate Breast cancer highest healthcare costs (6 billion Euros/year = 13% of the total cancer healthcare costs in the EU) Lung cancer highest total economic burden (19 billion Euros/ year of which 10 billion due to premature mortality) Luengo-Fernandez, R., Economic burden of cancer across the European Union: a population-based cost analysis, Lancet Oncol,

17 Cost of Illness Methodology: General Framework Cost of illness = Nr. of cases Nr. of cases * + * + Medical care costs case Non-medical costs case Nr. of cases * + Lost income case Non-personal costs + Pain & Suffering 17

18 Components of Total Cost of New Breast Cancer Cases in Year 1, % 27% 27% Productivity Losses Productivity Losses Non-medical Costs Non-medical Costs Medical Costs Medical Costs David Bloom, Harvard School of Public Health, November 4, 2009, Breast cancer in the developing world: meeting the unforeseen challenge to women, health and equity 18

19 Costs in CHF Example for Medical Costs in Switzerland Herceptin within Helsana I/III 8'000'000 Costs for Herceptin, '000'000 6'000'000 5'000'000 4'000'000 3'000'000 langzeit Long-term normal Short-term 2'000'000 1'000' year Helsana Data, 2014 Definition long-term: > 365 days between beginning and end of treatment 19

20 Costs in CHF Example for Medical Costs in Switzerland Herceptin within Helsana II/III 25'000'000 Costs for Herceptin in Age Groups 20'000'000 15'000'000 10'000'000 5'000' Age Group Helsana Data,

21 Costs in % Costs in CHF Example for Medical Costs in Switzerland Herceptin within Helsana III/III Costs for Herceptin in Age Groups 120% 12'000' % 10'000'000 80% 8'000'000 60% 6'000'000 40% 4'000'000 20% 2'000'000 0% Age Group langzeit long term - Bruttoleistung costs in CHF in CHF normal - Bruttoleistung costs in CHF in CHF langzeit long term - Bruttoleistung costs in % in % normal - Bruttoleistung costs in % in % - Helsana Data,

22 Number of cases Costs in CHF Example for Medical Costs in Switzerland Mammography within Helsana Mammography (M.): Number of Patients and Treatment Costs by Year (red cantons only) diagnostic, preventive and screening 50'000 45'000 40'000 35'000 30'000 6'000'000 5'000'000 4'000'000 25'000 20'000 15'000 10'000 5' year Diagnose diagnostic - M. Bruttoleistung in CHF Prävention preventive M. - Bruttoleistung in CHF Screening screening-m. - Bruttoleistung in CHF Diagnose number of - diagnostic Anzahl M. Prävention number of preventive - Anzahl M. Screening number of screening-m. - Anzahl 3'000'000 2'000'000 1'000'000 - Helsana Data, 2014 only for cantons without screening programs 22

23 Number of Patients Example for Medical Costs in Switzerland Treatment Costs by Agents within Helsana I/II 20'000 18'000 16'000 14'000 Total Number of Breast Cancer Patients by Agents 12'000 10'000 8'000 6'000 4'000 2' year Cytotoxic Agents Hormonal Agents Targeted Agents Helsana Data,

24 Costs in CHF Example for Medical Costs in Switzerland Treatment Costs by Agents within Helsana II/II 140'000'000 Total Costs of Breast Cancer Treatments by Agents 120'000' '000'000 80'000'000 60'000'000 Targeted Agents Hormonal Agents Cytotoxic Agents 40'000'000 20'000' Helsana Data, 2014 year 24

25 Economic Burden Burden of Disease Economic Burden Burden Containment Concluding Remarks 25

26 Reduce Economic Burden & Burden of Disease Assess Risk Faktors Assess Treatment Value Prevention Cost-effectiveness 26

27 Disease Containment Knowing the Risk Factors for Breast Cancer Oral Contraceptives Reproductive Factors Endogeneous Hormones Factors increasing the risk for cancer Hormone replacement Therapy Lifestyle Factors Youlden D.R. et al., The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality,

28 Disease Containment Endogenous Hormones Higher levels of endogenous hormones have long been hypothesized to increase breast cancer risk. Estrogen and Testosterone Prolactin Insulin Increase risk for breast cancer 28

29 Disease Containment Hormone Replacement Therapy Relative Risk of invasive breast cancer in relation to regency and type of HRT used HRT use at baseline Never users 1.00 ( ) Current users 1.66 ( ) Current users of oestrogen only 1.30 ( ) Current users of oestrogen-progestagen 2.00 ( ) Current users of tibolone 1.45 ( ) All past users 1.01 ( ) Last use <5 years previously 1.04 ( ) Last use 5-9 years previously 1.01 ( ) Last use 10 years previously 0.90 ( ) Relative risk (confidence interval) 66% 29

30 Disease Containment Oral Contraceptives Oral contraception and the relative risk of breast cancer Oral contraceptive use Relative risk (confidence interval) Never users 1.00 Current users 1.24 ( ) 1-4 years after stopping 1.16 ( ) 5-9 years after stopping 1.07 ( ) > 10 years after stopping 1.01 ( ) 30

31 Disease Containment Reproductive Factors Lower Risk of Breast Cancer Age Age at Menarche 1. Child 2. Child 3. Child Menopause Breastfeeding 1 year Breastfeeding 1 year Breastfeeding 1 year Higher Risk of Breast Cancer Age Age at Menarche 1. Child Menopause No breastfeeding 31

32 Disease Containment Lifestyle Risk Factors for Breast Cancer Alcohol consumption Height Body weight Medical radiation exposure Physical Activity Diet Smoking & secondhand smoking Medications In uterine exposure Shift work Risk Factors 32

33 Disease Containment Prevention with many Question Marks Who pays? When? Where? if. Prevention Mammography Who? How? 33

34 Disease Containment Why do we disagree? Because we need more data 34

35 Cost Containment Shift from Price to Value "A cynic is a man who knows the price of everything and the value of nothing." Oscar Wilde

36 Cost Containment Assessing the True Value is a True Challenge 36

37 Value, because values aren't constant factors Intrinsic Value (real value) Overestimation Underestimation Time 37

38 Economic Burden Burden of Disease Economic Burden Burden Containment Concluding Remarks 38

39 Which System do We Apply to Assess Value? Efficacy (Wirksamkeit) Appropriateness (Zweckmässigkeit) Cost-effectiveness (Wirtschaftlichkeit) With the following results: fast market access for new treatment Access to new treatments 39

40 WZW Results in High Costs for Switzerland Compared to the OECD mean, we spend a fair amount on pharmaceutical products however, the price level lies far beyond the OECD mean at 185% OECD maximum value! We can't benefit from having good accessibility if we can't afford anything anymore 40

41 Therefore, we need a system which is & 41

42 Thank you! Prof. Dr. Thomas D. Szucs Chairman of the Board, Helsana Versicherungen AG Director; Professor of Medicine Institute of Pharmaceutical Medicine European Center of Pharmaceutical Medicine Klingelbergstrasse 61 CH-4056 Basel E thomas.szucs@unibas.ch W