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Breaking down the costs for breast cancer: Insights from Sweden's national quality register 分解乳腺癌的成本：来自瑞典国家质量登记的见解

IF 7.9 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast

Pub Date : 2025-11-11 DOI: 10.1016/j.breast.2025.104646

Xiaoyang Du , Leo Gkekos , Balram Rai , Anna L.V. Johansson , Irma Fredriksson , Mattias Rantalainen , Emelie Heintz , Shuang Hao , Mark Clements

Background

With new emerging technologies for diagnostics and treatment for breast cancer, there is a demand for updated breast cancer costs based on current clinical practice. The objectives of this study were to estimate recent societal costs of breast cancer in Sweden and provide population-based patient-level cost estimates for health economic evaluations.

Methods

This prevalence-based cost-of-illness study was based on 2019 data linking multiple Swedish national registers. The analysis employed a societal perspective considering direct health care, informal care, and productivity losses. Total costs were estimated using a bottom-up micro-costing approach. Direct costs per patient-year were also estimated by subgroups, including age group, breast cancer subtype, breast cancer stage at diagnosis, and disease state defined by metastatic status.

Findings

82,960 breast cancer patients diagnosed since 2008 were alive by the end of 2019. The annual societal cost of breast cancer in Sweden was €632 million, where the direct health care, informal care, and productivity losses accounted for 37 %, 5 %, and 57 %, respectively. The cost per capita was €61. Costs of direct health care, including inpatient/outpatient care and prescribed drugs, varied by subgroups, where younger age, higher stage, and more adverse subtypes were associated with higher costs per patient-year. Patients with a diagnosis of de novo metastatic cancer incurred the highest mean cost per patient-year.

Conclusion

Breast cancer represents a large economic burden in Sweden. The mean cost estimates per patient-year are informative to future health economic evaluations for breast cancer screening and treatment.

随着乳腺癌诊断和治疗的新技术的出现，人们需要根据当前的临床实践更新乳腺癌的费用。本研究的目的是估计瑞典乳腺癌的近期社会成本，并为健康经济评估提供基于人群的患者水平成本估算。这项基于患病率的疾病成本研究基于2019年瑞典多个国家登记处的数据。该分析采用了社会视角，考虑了直接医疗保健、非正式护理和生产力损失。总成本是用自下而上的微观成本法估算的。每位患者年的直接费用也按亚组估计，包括年龄组、乳腺癌亚型、诊断时乳腺癌分期和转移状态定义的疾病状态。自2008年以来诊断出的82960名乳腺癌患者到2019年底还活着。在瑞典，乳腺癌的年度社会成本为6.32亿欧元，其中直接医疗保健、非正式护理和生产力损失分别占37%、5%和57%。人均费用为61欧元。直接医疗保健（包括住院/门诊护理和处方药）的费用因亚组而异，其中年龄较小、分期较高和不良亚型较多与每位患者年的费用较高相关。诊断为新发转移性癌症的患者每年的平均费用最高。结论乳腺癌是瑞典的一大经济负担。每位患者每年的平均费用估计为未来乳腺癌筛查和治疗的健康经济评估提供了信息。

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引用次数: 0

The Breast International Group (BIG) Patient Partnership: Embedding meaningful patient involvement in the design and conduct of breast cancer clinical research 乳腺国际组织（BIG）患者合作：将有意义的患者参与到乳腺癌临床研究的设计和实施中。

IF 7.9 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast

Pub Date : 2025-11-10 DOI: 10.1016/j.breast.2025.104642

Carmela Caballero , Virginie Adam , Orsolya Birta , Lydie Meheus , Judy Needham , Christine Hodgdon , Leslie Gilhams , Concepcion Biurrun , Mairead MacKenzie , Tanja Spanic , Hilary Stobart , Lynda Belhadi , Julia Maués , Ana Casas , Eva Schumacher-Wulf , Carolyn Straehle , Seamus O'Reilly , David Cameron , Martine Piccart , Judith Bliss , Boon Chua

Involving those with a lived experience of the relevant condition in the design of clinical research ensures that studies address real-world needs and priorities, enabling more relevant, ethical, and impactful outcomes. In 2019, the Breast International Group (BIG) established the BIG Patient Partnership to facilitate the meaningful involvement of people affected by breast cancer in the design and conduct of its studies. The members provide a strong international patient voice in academic breast cancer research. The partnership is based on 4 pillars: foundational and ongoing training, meaningful and systematic involvement, patients as a strategic driving force in BIG's research, and promoting the value of the patients' voice in research. In this paper, we describe a model to enable performing transnational clinical research for and with patient partners. We hope to inspire organizations and people who are burdened by cancer from different cultural backgrounds to develop an interactive, engaging, and empowering process for researchers and patient partners to work together.

在临床研究的设计中，让那些有相关疾病生活经验的人参与进来，可以确保研究满足现实世界的需求和优先事项，从而实现更相关、更符合伦理、更有影响力的结果。2019年，乳腺国际集团（BIG）建立了BIG患者合作伙伴关系，以促进乳腺癌患者有意义地参与其研究的设计和实施。其成员为乳腺癌学术研究提供了强有力的国际患者声音。该合作伙伴关系基于四大支柱：基础和持续培训，有意义和系统的参与，患者作为BIG研究的战略推动力，以及促进患者在研究中的价值。在本文中，我们描述了一个模型，使执行跨国临床研究与患者的合作伙伴。我们希望激励来自不同文化背景的组织和受癌症困扰的人们，为研究人员和患者合作伙伴开发一个互动、吸引人、赋权的过程。

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引用次数: 0

Omission of sentinel lymph node biopsy in early stage luminal breast cancer: impact on adjuvant CDK4/6 inhibitor recommendation and oncological outcomes 早期腔内乳腺癌遗漏前哨淋巴结活检：对辅助CDK4/6抑制剂推荐和肿瘤预后的影响

IF 7.9 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast

Pub Date : 2025-11-07 DOI: 10.1016/j.breast.2025.104641

Martin Heidinger , Tibor A. Zwimpfer , Florian S. Halbeisen , Nadia Maggi , Marie Louise Frevert , Rama Kiblawi , Julie M. Loesch , Fabienne D. Schwab , Christian Kurzeder , Giacomo Montagna , Walter P. Weber

Background

Sentinel lymph node biopsy (SLNB) omission is safe in many patients with small, clinically and imaging node-negative (cN0/iN0), hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC). However, recruitment of the pivotal SOUND/INSEMA trials ended prior to approval of adjuvant cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). Therefore, the impact of SLNB omission on eligibility for CDK4/6i and associated oncological outcomes is unknown.

Methods

Single-center, retrospective study including patients with ≤cT2, cN0/iN0, HR-positive/HER2-negative early BC who underwent breast-conserving surgery and SLNB between 01/2014-12/2024. CDK4/6i eligibility was based on monarchE inclusion criteria and FDA approval (abemaciclib) and NATALEE inclusion criteria (ribociclib). Predictors of CDK4/6i eligibility and node-positivity were identified using multivariable logistic regression analysis. Impact on invasive disease-free survival was estimated based on published number needed to treat values in stage II disease (abemaciclib 28; ribociclib 63).

Results

Among 309 patients, eligibility was 6.1 % (19/309), 3.2 % (10/309), and 7.8 % (24/309) for abemaciclib (monarchE), abemaciclib (FDA approval), and ribociclib based on node-criteria; consequently, the number of SLNB necessary to identify one eligible patient was 17 (95 %CI 11–27), 31 (95 %CI 17–64) and 13 (95 %CI 9–20). Lymphovascular invasion was identified as a predictor for CDK4/6i eligibility and node-positivity. Omitting SLNB could increase recurrences by 0.3 % (95 %CI 0.2–0.4), 0.2 % (95 %CI 0.1–0.3), and 0.2 % (95 %CI 0.1–0.2) due to missed treatment with abemaciclib (monarchE), abemaciclib (FDA approval), and ribociclib, respectively.

Conclusion

Omission of SLNB in patients with small HR-positive/HER2-negative tumors results in a missed indication for CDK4/6i in <8 % with minimal impact on recurrence.

背景：前哨淋巴结活检（SLNB）遗漏对于许多临床和影像学淋巴结阴性（cN0/iN0）、激素受体（HR）阳性、人表皮生长因子受体2 （HER2）阴性乳腺癌（BC）患者是安全的。然而，关键SOUND/INSEMA试验的招募在辅助细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6i）获批之前就结束了。因此，SLNB缺失对CDK4/6i治疗资格和相关肿瘤预后的影响尚不清楚。方法采用单中心回顾性研究，纳入2014年1月- 2024年12月期间接受保乳手术和SLNB的≤cT2、cN0/iN0、hr阳性/ her2阴性早期BC患者。CDK4/6i的资格基于monarchE纳入标准、FDA批准（abemaciclib）和NATALEE纳入标准（ribociclib）。使用多变量logistic回归分析确定CDK4/6i适格性和节点阳性的预测因子。对侵袭性无病生存的影响是基于II期疾病治疗价值所需的已发表数量（abemaciclib 28; ribociclib 63）。结果309例患者中，基于淋巴结标准的abemaciclib （monarchE）、abemaciclib （FDA批准）和ribociclib的适格率分别为6.1%（19/309）、3.2%（10/309）和7.8% (24/309)；因此，确定一名合格患者所需的SLNB数量为17 (95% CI 11-27), 31 （95% CI 17 - 64）和13 （95% CI 9-20）。淋巴血管侵袭被确定为CDK4/6i适格性和淋巴结阳性的预测因子。由于错过了abemaciclib （monarchE）、abemaciclib （FDA批准）和ribociclib的治疗，忽略SLNB可能会增加0.3% （95% CI 0.2 - 0.4）、0.2% （95% CI 0.1-0.3）和0.2% （95% CI 0.1-0.2）的复发率。结论在小的hr阳性/ her2阴性肿瘤患者中进行SLNB治疗会导致遗漏CDK4/6i指征的比例为8%，对复发的影响很小。

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