2Healthcare resource utilization for first line chemotherapy
versus endocrine therapy in patients with advanced
HR-positive/HER2-negative breast cancer in Taiwan

Dwan-Yin Chang ＊ 1, Yi-Chen Juan ＊ 2, Yen-Shen Lu ＊ 1, Jiun-Jen Lynn ＊ 3,Chih-Ta Chien ＊ 3, Fan-Chen Ku ＊ 3, K Arnold Chan ＊ 1, 2
Corresponding author
K Arnold Chan
Abstract
Objective
The goal of this retrospective database analysis was to describe treatment patterns, compare healthcare
resource utilization, and evaluate frequency of potential treatment-related toxicity among patients with hormone
receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2–) advanced breast
cancer using upfront endocrine therapy or chemotherapy, as well as to assess the effect of choice of systemictreatment on survival outcome in Taiwan.
Methods
Eligible HR+ HER2– advanced breast cancer patients were identified using Taiwan Cancer Registry from2011-2017 and Taiwan National Health Insurance database from 2011-2018 and classified as those who received
first line chemotherapy or endocrine therapy. Comparisons between these two groups were made in terms ofnumber of hospitalization episodes, hospitalization duration, healthcare resource utilization and frequency ofpotential treatment-related toxicity. Survival outcomes were evaluated by Kaplan-Meier method.
Results
There were 2,874 patients with HR+ HER2– advanced breast cancer during the study period, 42% of themreceived first line endocrine therapy and 56% received first line chemotherapy. Mean hospitalization episodes
were higher in the first line chemotherapy group compared to first line endocrine therapy in the first year after
initial breast cancer diagnosis, and the number of hospitalization episodes were similar in the second and thirdyear. Treatment for adverse events likely to be associated with cancer treatment, such as blood transfusion,
emergency department visits, use of granulocyte-stimulating colony factor, anti-inflammatory medication andintravenous antibiotics were more commonly administered in patients who received chemotherapy as initial
therapy. Multiple regression analysis showed that first line chemotherapy as initial therapy was associated withhigher level of healthcare resource utilization in the first year compared to first line endocrine therapy but thedifferences were not statistically significant in the second and third year. Use of chemotherapy or endocrine
therapy were associated with similar survival outcomes over three years.
＊1 National Taiwan University Hospital＊2 Health Data Research Centre, National Taiwan University＊3 Novartis (Taiwan) Co. Ltd.

Healthcare resource utilization for first line chemotherapy versus endocrine therapy inpatients with advanced HR-positive/HER2-negative breast cancer in Taiwan

3Conclusion
In Taiwan, a higher percentage of patients with HR+ HER2– advanced breast cancer were started onchemotherapy in the recent decade, more frequent hospitalizations and higher incidence of adverse events wereassociated with the use of chemotherapy, and they had higher healthcare resource utilization than those who wereprescribed endocrine therapy. Data from this analysis can help inform optimal management of advanced breastcancer.
[Keywords] Taiwan National Health Insurance database, HR+ HER2– advanced breast cancer, chemotherapy,
endocrine therapy, healthcare resource utilization