Understanding trends of US breast cancer hospitalization, mortality and costs using the National Inpatient Sample database.
Authors: Arun Kumar, Zeeshan Solangi, Emeka Agudile, Oday Elmanaseer, Ghulam Shah, Amirta Devi, Kristen Danielle Whitaker
Journal: Journal of Clinical Oncology (2024)

11162 Background: Studies have shown a rising breast cancer incidence in the US. However, its impact on healthcare utilization is unclear. Our study delves into the previously unexplored territory of hospitalization and cost trends among breast cancer patients, aiming to shed light on resource allocation and potential areas for improvement. Methods: To investigate trends in breast cancer admissions and costs, we queried the National Inpatient Sample database. Patients admitted between January 2011 and December 2019 with following criteria were included in the analysis: female gender, age ≥ 18, and ICD diagnosis code corresponding to unspecified malignant neoplasm of the breast as their primary reason for admission. Our primary outcome was defined as the temporal trends in the number of admissions, discharge rates, length of stay, and cost of hospitalization and mortality rates. Analyses were performed using Stata version 15.1 College station TX: StataCorp LP 2017. Appropriate discharge weights were applied to the dataset during the analyses to account for critical elements of sampling design. A p-value of &lt;0.05 was considered statistically significant. Results: Between 2011 and 2019, hospital admissions for breast cancer as the primary diagnosis declined significantly, from 32,126 to 12,742 (P &lt; 0.001). However, while average length of stay increased slightly from 4.3 to 4.9 days (P &lt; 0.01), hospital charges for breast cancer rose dramatically. Adjusted for inflation, mean charges per patient rose 38.8%, from $50,663.86 in 2011 to $70,334.11 in 2019 (P &lt; 0.001). Despite this surge, the total aggregate cost ("national burden") of hospitalizations with breast cancer as main discharge diagnosis decreased, falling from $1.63 billion in 2011 to $896 million in 2019 (inflation adjusted) (P &lt; 0.001). Discharges for breast cancer peaked in women between 45 and 64, followed by the 65-84 demographic. Compared to the overall decrease in hospitalization rates, the declines in the above age groups were notably steeper with declines of 62% for 45-64 and 48% for 65-84 (p&lt;0.001). Although absolute number of breast cancer deaths decreased from 2011 to 2019, the mortality rate paradoxically increased from 4.3% to 5.8% over the same period (P &lt; 0.001). This seemingly contradictory trend warrants further investigation to better understand contributing factors. Conclusions: While breast cancer diagnoses are on the rise in women, our study reveals a fascinating paradox: significant declines in hospitalization, associated costs, and overall mortality. This encouraging trend likely stems from widespread surveillance mammography with increases in early stage, curable disease diagnosis, and the flourishing landscape of outpatient therapies, including targeted treatments, with more tolerable toxicity profiles allowing for majority of breast cancer care to be completed in the outpatient setting.