Tripthi Kamath

Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma

Background:  Characterization of uncontrolled asthma burden in a natural treatment setting can influence treatment recommendations and clinical practice. The objective was to characterize and compare the economic burden of severe or difficult‐to‐treat asthma in uncontrolled and controlled patients.

Identification and cost of adverse events in metastatic breast cancer in taxane and capecitabine based regimens

PurposeWe sought to compare the economic impact of treatment-related adverse events (AEs) in patients with metastatic breast cancer (mBC) using taxane- or capecitabine-based treatment regimens as either first- or second-line (FL or SL) therapy in the US.MethodsWe used healthcare claims data from the Truven Health Analytics MarketScan® Commercial Databases to conduct a retrospective cohort study comparing the economic impact of AEs amongst taxane- and capecitabine-treated mBC patients in the US. We selected women diagnosed with mBC between 2008–2010 who received a taxane or capecitabine as first- or second-line (FL or SL) chemotherapy. Costs related to hospitalization, outpatient services, emergency department visits, chemotherapy and other medications were tabulated and combined to determine total healthcare costs. The incremental monthly costs associated with the presence of AEs compared to no AEs were estimated using generalized linear models, controlling for age and Charlson Comorbidity Index.ResultsWe identified 15,443 mBC patients meeting inclusion criteria. Adjusted total monthly costs were significantly higher in those who experienced AEs than in those without AEs in both lines of treatment (FL incremental cost: taxanes

Individual attributions of living longer with HER2+ metastatic breast cancer: Findings from a community web-based survey.

1,142, capecitabine

Abstract P5-21-03: Delay in trastuzumab initiation leads to decreased overall survival in patients with HER2+ early stage breast cancer

1,817; SL incremental cost: taxanes

Asthma control, severity, and quality of life: Quantifying the effect of uncontrolled disease

1,448, capecitabine

Economic burden of impairment in children with severe or difficult-to-treat asthma

4,437). Total costs increased with the number of AEs and were primarily driven by increased hospitalization amongst those with AEs.ConclusionsAdverse events in taxane- or capecitabine-treated mBC patients are associated with significant increases in costs. Selecting treatment options associated with fewer AEs may reduce costs and improve outcomes in these patients.

Evaluation of Erlotinib in Advanced Non-Small Cell Lung Cancer: Impact on the Budget of a U.S. Health Insurance Plan

197 Background: Advances in targeted therapy have led to an increase in the median overall survival in patients with HER2+ metastatic breast cancer (MBC). However, patient attributions related to living longer have not been studied. METHODS A one-time, web-based survey was administered through multiple US-based breast cancer organizations. The inclusion criteria were being female, age 18+, having HER2+ MBC, and living in the US. The surveys included health related quality of life (HRQL), symptom burden, activities of daily living, satisfaction with medical care, work productivity, and attributes of living longer. To assess beliefs about length of survival with HER2+ MBC, participants were asked to rate the importance of 16 items. Descriptive results were stratified by time since metastatic diagnosis and HRQL. RESULTS Of 560 attempted surveys, 365 (65%) participants met inclusion criteria. Mean (SD) age was 53.6 (10.5) years, 93% were white, and 27% reported having participated in a clinical trial. 59% of respondents reported living ≥4 years since HER2+ MBC diagnosis. Common reasons patients gave for living longer included: choosing the right doctor/medical team (91%), having a positive outlook on life (79%), and learning about the disease or treatments (79%). Women with <4 years since HER2+ MBC diagnosis were more likely to report having a positive outlook on life (85% vs 76%), using complementary and alternative medicine (45% vs 36%) and exercising regularly (74% vs 66%) compared with those having ≥4 years since diagnosis. Women reporting a better compared with a poorer HRQL reported more frequent regular exercise (73% vs 49%) and more often had a positive outlook on life (86% vs 64%). CONCLUSIONS To our knowledge, this is the first study of women with HER2+ MBC and their attributions about length of survival. Having the right medical team, remaining positive, and being educated about the disease and its treatments were most important to participants. Women reporting better quality of life were more likely to report multiple attributions of living longer. HRQL and patient perceptions about their survival are important factors that should be considered in providing patient-centered care.

Survival in patients with non-metastatic breast cancer treated with adjuvant trastuzumab in clinical practice

Background Trastuzumab reduces the risk of relapse in women with HER2+ early stage breast cancer. Yet, little information exists on the timing of trastuzumab initiation and its association with relapse and survival outcomes in these patients. The study aimed to investigate the impact of delaying the initiation of adjuvant trastuzumab treatment for >6 months on time to relapse, overall survival, and relapse-free survival among patients with HER2+ early stage breast cancer who did not receive neoadjuvant therapy. Methods Adult women initiating trastuzumab adjuvant therapy within 1 year of breast cancer surgery who did not receive neoadjuvant therapy were selected from the US Department of Defense health claims database from 01/2003 to 12/2012 (N = 2,749). By design, participants had to be alive and relapse-free at the time they initiated adjuvant trastuzumab. Patients were classified into two groups based on the time from breast cancer diagnosis to trastuzumab initiation: ≤6 months and >6 months. An algorithm based on secondary neoplasm ICD9 codes along with treatment gaps and initiations was used to identify relapses. Percent relapses and/or deaths were reported by study groups and compared using χ 2 tests. The impact of delaying trastuzumab initiation on time to relapse, overall survival, and relapse-free survival was estimated from Cox regression models adjusted for age, overall comorbidity profile at the time of the BC diagnosis (Charlson index), type of surgery (breast conserving vs. breast removing), and radiotherapy (prior to the initiation of trastuzumab). In all three Cox models the follow-up started at adjuvant trastuzumab initiation. Results Of 2,749 women who met the selection criteria, 79.3% initiated adjuvant trastuzumab ≤6 months of diagnosis and 20.7% initiated adjuvant trastuzumab >6 months after the diagnosis (Table). Patients who delayed the initiation of trastuzumab for >6 months were younger (57.2% aged p = .008) and a higher proportion of them received radiotherapy prior to the initiation of trastuzumab compared to those who initiated trastuzumab earlier (77.2% vs. 53.1%, p 6 months after diagnosis had a higher risk of relapse, death, or relapse/death than those who initiated trastuzumab ≤6 months of diagnosis in both unadjusted and adjusted analyses (Table). Conclusions The results of this population-based study among patients with HER2+ early stage breast cancer who did not receive neoadjuvant therapy suggest that delays of over 6 months in the initiation of trastuzumab among HER2+ early stage breast cancer patients are associated with a higher risk of relapse and shorter overall survival and relapse-free survival. Disclaimer Research derived from an IRB approved protocol at Naval Medical Center Portsmouth, VA. The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Department of the Navy, Department of Defense or the United States Government. Dr. C.G. and Dr. K.M. are members of the U.S. military. This work was prepared as part of their official duties. Title 17 U.S.C. 105 provides that 9Copyright protection under this title is not available for any work of the United States Government.9 Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person9s official duties. Citation Format: Christopher M Gallagher, Kenneth More, Anthony Masaquel, Tripthi Kamath, Annie Guerin, Raluca Ionescu-Ittu, Marjolaine Gauthier-Loiselle, Roy Nitulescu, Nicholas Sicignano, Brian Barnett, Eric Wu. Delay in trastuzumab initiation leads to decreased overall survival in patients with HER2+ early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-21-03.