Factors associated with the adoption of targeted therapy for human epidermal growth factor receptor 2 (HER 2) positive breast cancer_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Xin ¹ , WU Qiyou ¹ , LIAN Zhiwei ² ,  SUN Jing ¹ , WU Fan ² , ZHANG Gong ² , LIU Jian ² , CHEN Chuanben ²

1. School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, P. R. China;
2. Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, P. R. China;

Corresponding?author：

SUN Jing, Email: sunjing@sph.pumc.edu.cn

Keywords：

Breast cancer; Human epidermal growth factor receptor 2; Targeted therapy; Influencing factor; Logistic regression

DOI：

10.7507/1672-2531.202208115

Video：

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Objective To analyze the factors associated with the adoption of targeted therapy in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and to generate evidence to inform decision-making on public security policy regarding innovative anticancer medicines for the benefit of patients. Methods The study population comprised female patients diagnosed with HER2-positive breast cancer and treated at Fujian Cancer Hospital from 2014 to 2020. The patients were eligible for targeted therapy. The demographic and sociological characteristics and clinical information of patients were extracted from the hospital information system. We performed binary logistic regression analysis of factors associated with the adoption of targeted therapy in patients with HER2-positive breast cancer. We also divided the participants into two groups according to their tumor stage for subgroup analysis. Results A total of 1 041 female patients with HER2-positive breast cancer were included, among them, 803 received targeted therapy. In September 2017, molecular-targeted medicines for HER2-positive breast cancer began to be included in the local basic health insurance program. Only 282 (35.1%) patients adopted targeted therapy before September 2017, after which this number increased to 521 (64.9%). Among the patients who adopted targeted therapy, most were formally employed (45.8%) and enrollees of the urban employee health insurance program (66.0%). Among those who did not adopt targeted therapy, most were unemployed (42.4%) and enrollees of the resident health insurance program (50.0%). Binary logistic regression analysis revealed that patient occupation, gene expression of estrogen receptor, tumor stage, surgery or not, radiotherapy or not, and undergoing treatment before or after September 2017 were correlated with the adoption of targeted therapy (P<0.05). Conclusions Inclusion of targeted medicines for HER2-positive breast cancer in the health insurance program substantially increased the overall administration of these therapies. Individual affordability is a critical factor associated with the application of targeted therapy in eligible patients. Future policies should enhance the public security of patients with a relatively weak ability to pay and provide insurance coverage for innovative anti-cancer medicines.

Citation： WANG Xin, WU Qiyou, LIAN Zhiwei, SUN Jing, WU Fan, ZHANG Gong, LIU Jian, CHEN Chuanben. Factors associated with the adoption of targeted therapy for human epidermal growth factor receptor 2 (HER 2) positive breast cancer. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 7-13. doi: 10.7507/1672-2531.202208115 Copy

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2.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3.	Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
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25.	Sruamsiri R, Wagner AK, Ross-Degnan D, et al. Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis. BMJ Open, 2016, 6(3): e008671.
26.	Moye-Holz D, van Dijk JP, Reijneveld SA, et al. The impact of price negotiations on public procurement prices and access to 8 innovative cancer medicines in a middle-income country: the case of Mexico. Value Health Reg Issues, 2019, 20: 129-135.
27.	Sruamsiri R, Ross-Degnan D, Lu CY, et al. Policies and programs to facilitate access to targeted cancer therapies in Thailand. PLoS One, 2015, 10(3): e0119945.
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1. Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health, 2018, 6(5): e555-e567.
2. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
3. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet, 2018, 391(10125): 1023-1075.
4. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
5. 中國共產黨中央委員會, 中華人民共和國國務院. “健康中國2030”規劃綱要. Available at: http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
6. 中華人民共和國政府. 國家衛生計生委辦公廳關于公布國家藥品價格談判結果的通知(國衛辦藥政函〔2016〕515號). Available at: http://www.gov.cn/xinwen/2016-05/20/content_5075027.htm.
7. 中華人民共和國人力資源和社會保障部. 人力資源社會保障部關于將36種藥品納入國家基本醫療保險、工傷保險和生育保險藥品目錄乙類范圍的通知(人社部發〔2017〕54號). Available at: http://www.mohrss.gov.cn/SYrlzyhshbzb/shehuibaozhang/zcwj/201707/t20170718_274153.html.
8. 國家醫療保障局. 國家醫療保障局關于將17種抗癌藥納入國家基本醫療保險、工傷保險和生育保險藥品目錄乙類范圍的通知(醫保發〔2018〕17號). Available at: http://www.nhsa.gov.cn/art/2018/10/10/art_37_1057.html.
9. 國家醫療保障局, 中華人民共和國人力資源和社會保障部. 國家醫保局人力資源社會保障部關于將2019年談判藥品納入《國家基本醫療保險、工傷保險和生育保險藥品目錄》乙類范圍的通知(醫保發〔2019〕65號). Available at: http://www.nhsa.gov.cn/art/2019/11/28/art_37_2050.html.
10. 國家醫療保障局, 中華人民共和國人力資源和社會保障部. 國家醫保局人力資源社會保障部關于印發《國家基本醫療保險, 工傷保險和生育保險藥品目錄(2020年)》的通知(醫保發〔2020〕53號). Available at: http://www.nhsa.gov.cn/art/2020/12/28/art_37_4220.html.
11. 國家醫療保障局, 中華人民共和國人力資源和社會保障部. 國家醫保局人力資源社會保障部關于印發《國家基本醫療保險, 工傷保險和生育保險藥品目錄(2021年)》的通知(醫保發〔2021〕50號). Available at: http://www.nhsa.gov.cn/art/2021/12/3/art_37_7429.html.
12. Harbeck N, Gnant M. Breast cancer. Lancet, 2017, 389(10074): 1134-1150.
13. Dean-Colomb W, Esteva FJ. Her2-positive breast cancer: herceptin and beyond. Eur J Cancer, 2008, 44(18): 2806-2812.
14. 張佩雯, 張輝, 李明爽, 等. 人表皮生長因子受體2陽性乳腺癌患者治療后生存質量及影響因素研究. 中國循證醫學雜志, 2021, 21(5): 532-538.
15. Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol, 2012, 13(1): 25-32.
16. Uriarte-Pinto M, Escolano-Pueyo á, Gimeno-Ballester V, et al. Trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel in the neoadjuvant setting of HER-2 positive breast cancer. Int J Clin Pharm, 2016, 38(2): 446-453.
17. 武正炎. NCCN乳腺癌臨床實踐指南(2006版)簡介. 實用臨床醫藥雜志, 2006, 10(3): 34-35.
18. 許鳳銳. 乳腺癌NCCN指南中國歷程: 2006-2016. 第19屆全國臨床腫瘤學大會暨2016年CSCO學術年會論文集, 2016.
19. 中國抗癌協會乳腺癌專業委員會. 中國抗癌協會乳腺癌診治指南與規范(2021年版). 中國癌癥雜志, 2021, 31(10): 954-1040.
20. Li J, Wang S, Wang Y, et al. Disparities of trastuzumab use in resource-limited or resource-abundant regions and its survival benefit on HER2 positive breast cancer: a real-world study from China. Oncologist, 2017, 22(11): 1333-1338.
21. 張文婷, 桂玲, 劉東. 2009~2011年武漢地區抗腫瘤分子靶向治療藥物應用分析. 藥物流行病學雜志, 2013, 22(1): 32-34.
22. 方欣, 田夢媛, 張欲曉, 等. 藥品不同準入價格對醫保基金及個人可負擔性的影響——以部分抗腫瘤靶向藥物為例. 中國衛生政策研究, 2016, 9(11): 40-44.
23. 國家醫療保障局. 國家醫療保障局對十三屆全國人大二次會議第6795號建議的答復(醫保函〔2019〕72號). Available at: http://www.nhsa.gov.cn/art/2019/8/14/art_110_6689.html.
24. 王煜昊, 徐偉, 路娜娜, 等. "4+7"集中帶量采購實施效果分析—基于9試點地區藥品銷售數據. 中國衛生政策研究, 2021, 14(2): 36-43.
25. Sruamsiri R, Wagner AK, Ross-Degnan D, et al. Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis. BMJ Open, 2016, 6(3): e008671.
26. Moye-Holz D, van Dijk JP, Reijneveld SA, et al. The impact of price negotiations on public procurement prices and access to 8 innovative cancer medicines in a middle-income country: the case of Mexico. Value Health Reg Issues, 2019, 20: 129-135.
27. Sruamsiri R, Ross-Degnan D, Lu CY, et al. Policies and programs to facilitate access to targeted cancer therapies in Thailand. PLoS One, 2015, 10(3): e0119945.
28. Moye-Holz D, Soria Saucedo R, van Dijk JP, et al. Access to innovative cancer medicines in a middle-income country - the case of Mexico. J Pharm Policy Pract, 2018, 11: 25.
29. Bazargani YT, de Boer A, Schellens JH, et al. Selection of oncology medicines in low- and middle-income countries. Ann Oncol, 2014, 25(1): 270-276.
30. Exarchakou A, Rachet B, Belot A, et al. Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ, 2018, 360: k764.
31. Kumachev A, Trudeau ME, Chan KK. Associations among socioeconomic status, patterns of care and outcomes in breast cancer patients in a universal health care system: Ontario's experience. Cancer, 2016, 122(6): 893-898.
32. Doshi JA, Li P, Huo H, et al. Association of patient out-of-pocket costs with prescription abandonment and delay in fills of novel oral anticancer agents. J Clin Oncol, 2018, 36(5): 476-482.
33. Fwelo P, Yusuf ZI, Adjei A, et al. Racial and ethnic disparities in the refusal of surgical treatment in women 40 years and older with breast cancer in the USA between 2010 and 2017. Breast Cancer Res Treat, 2022, 194(3): 643-661.
34. Diao Y, Lin M, Xu K, et al. Impact of public health insurance coverage of novel anticancer medication on medical expenditure and patient affordability in a provincial medical centre of China: a propensity score-matching analysis with the quasi-experimental design. BMJ Open, 2022, 12(2): e054713.
35. Diao Y, Lin M, Xu K, et al. How government health insurance coverage of novel anti-cancer medicines benefited patients in China - a retrospective analysis of hospital clinical data. BMC Health Serv Res, 2021, 21(1): 856.
36. 李明爽, 刁一凡, 葉建春, 等. 國家談判靶向抗乳腺癌藥物納入基本醫療保險政策患者惠及研究. 藥物流行病學雜志, 2021, 30(6): 398-403,428.
37. Li M, Diao Y, Ye J, et al. The public health insurance coverage of novel targeted anticancer medicines in China-in favor of whom. A retrospective analysis of the insurance claim data. Front Pharmacol, 2021, 12: 778940.
38. 羅格蓮, 林瑾文, 林永順, 等. 福建省乳腺癌靶向藥物治療現狀及其治療費用分析. 藥學研究, 2016, 35(11): 673-676.
39. 楊爽, 王艷, 徐偉, 等. 江蘇省常州市特藥保障政策實施成效評估研究: 以HER-2陽性乳腺癌為例. 中國衛生經濟, 2017, 36(3): 43-45.
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