Real-world analysis of the economic and therapeutic burden in advanced breast cancer patients in Italy

Background: This real-world analysis evaluated drug utilization focusing on wastage and healthcare costs
for treatment of patients with advanced breast cancer (aBC) hormone receptor-positive (HR+)/human
epidermal growth factor receptor-2 negative (HER2-) in Italy.
Methods: A retrospective analysis was conducted on administrative data covering about 13.3 million
health-assisted individuals. Across January/2017–June/2021, all patients with HR+/HER2-aBC were
identified by ≥ 1 prescription for cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i). Cost analysis was
performed and updated referring to the prices of November 2021.
Results: Overall, 3,647 HR+/HER2-aBC patients were included (2,627 palbociclib treated, 729 ribociclib
treated, and 291 abemaciclib treated). After 12 months of follow-up, 35% of palbociclib patients had
a dose reduction (on average 8.9 wasted pills/patient), 44.7% of abemaciclib patients had a dose
reduction (on average 6.7 wasted pills/patient), 22.1% of ribociclib patients had a dose reduction (no
wasted pills). Therapy wastage added up to 528,716€ for palbociclib-treated patients (524€/patient) and
5,738€ in abemaciclib-treated patients (151€/patient). No wastage was attributed to ribociclib.
Conclusions: Dose reduction was associated with drug wastage in palbociclib and abemaciclib-treated
patients, but not in ribociclib-treated ones. These findings might be helpful to policy decision-makers
who, for healthcare strategies implementation, among several variables should consider the possible
restraining of drug wastage