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Treatment patterns, clinical outcomes and health care costs associated with her2-positive breast cancer with central nervous system metastases: a French multicentre observational study

Sandrine Baffert1*, Paul Cottu2, Youlia M Kirova3, Florence Mercier4, Cécile Simondi5, Thomas Bachelot6, Emilie Le Rhun7, Christelle Levy8, Maya Gutierrez9, Nicolas Madranges10, Cristian Moldovan11, Bruno Coudert12, Dominique Spaëth13, Daniel Serin14, François-Emery Cotté15, Laure Benjamin15, Cathie Maillard16, Sabine Laulhere-Vigneau16 and Isabelle Durand-Zaleski17

Author Affiliations

1 Department of Public Health, Health Economics unit, Institut Curie, 26 rue d’Ulm, Paris 75005, France

2 Department of Medical Oncology, Institut Curie, Paris, France

3 Department of Radiation Oncology, Institut Curie, Paris, France

4 Stat Process, Port-Mort, France

5 Department of Clinical Research, Institut Curie, Paris, France

6 Department of Medical Oncology, Centre Léon Bérard, Lyon, France

7 Neurology, Medical Oncology Department, Oscar Lambret Center, Lille, France and Neuro-oncology, University Hospital, Lille, France

8 Department of Medical Oncology, Centre François Baclesse, Caen, France

9 Department of Medical Oncology, Institut Curie, Saint-Cloud, France

10 Department of Medical Oncology, Institut Bergonié, Bordeaux, France

11 Department of Medical Oncology, Centre Henri Becquerel, Rouen, France

12 Department of Medical Oncology, Centre JF Leclerc, Dijon, France

13 Department of Medical Oncology, Centre d’Oncologie de Gentilly, Nancy, France

14 Department of Medical Oncology, Institut Sainte Catherine, Avignon, France

15 Department of Pharmaco-Epidemiology and Health Outcomes Research, GlaxoSmithKline, Marly-le-Roi, France

16 Ceri Medical, Garches, France

17 Hôpital Henri-Mondor, Créteil, France

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BMC Health Services Research 2013, 13:456  doi:10.1186/1472-6963-13-456

Published: 31 October 2013



The population of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) who develop central nervous system (CNS) metastases is growing. Treatment strategies in this population are highly diverse. The objective of the study was to assess health care costs for the management of HER2 positive BC with CNS metastases.


This multicentre, retrospective, observational study was conducted on HER2-positive BC patients diagnosed with CNS metastases between 2006 and 2008. Data were extracted from patient medical records to estimate health care resource use. A partitioned estimator was used to adjust censoring costs by use of the Kaplan-Meier survival estimate.


218 patients were included and costs were estimated for 200 patients. The median time to detection of CNS metastases was 37.6 months. The first metastatic event involved the CNS in 39 patients, and this was the unique first metastatic site in 31 of these patients. Two years following diagnosis of CNS metastases, 70.3% of patients had died. The mean per capita cost of HER2-positive BC with CNS metastases in the first year following diagnosis was €35,735 [95% CI: 31,716-39,898]. The proportion of costs attributed to expensive drugs and those arising from hospitalisation were in the same range.


A range of individualised disease management strategies are used in HER2-positive BC patients with CNS metastases and the treatments used in the first months following diagnosis are expensive. The understanding of cost drivers may help optimise healthcare expenditure and inform the development of appropriate prevention policies.

Costs and cost analysis; Cerb-2; HER2-positive; Breast cancer; Brain metastases; Health care costs; Treatment pattern