Liu, Yuki

ABSTRACT Background and Objectives Among patient with early‐stage breast cancer, breast conservation surgery (BCS) is the most performed surgery, utilized in approximately two‐thirds of patients. While 5‐year overall‐survival rates are strong—typically above 90%—additional re‐excisions can occur in up to 25% of patients who undergo index BCS and some patients will require subsequent surgery for new breast cancer or recurrences. As such, these additional procedures can complicate patients’ pathway to survivorship, negatively impact quality of life, and lead to excess healthcare costs. Methods This retrospective cohort study used linked claims and an electronic healthcare record database to (1) characterize patients at higher risk for additional breast oncologic surgery (aBOS) following BCS, and (2) quantify the long‐term financial impact of aBOS after BCS. In total, 87,190 patients with breast cancer, who had an index BCS between January 1, 2012, to March 31, 2023, were followed for up to 5‐years post‐operatively. Patients with and without aBOS were analyzed, comparing demographics, tumor characteristics, healthcare utilization, and per‐person‐per‐month (PPPM) costs. Results Twenty‐three percent ( n = 20,212) of patients underwent aBOS. These patients were younger, had higher tumor grades and larger tumor sizes, and incurred greater healthcare costs compared to patients who did not undergo a secondary surgery. Conclusion This study highlights significant factors influencing BCS outcomes and healthcare utilization, underscoring the need for tailored therapeutic strategies for patients with breast cancer.

Abstract Objective To evaluate 2-year cost to insured patients treated with Roux-en-Y gastric bypass (RYGB) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for type 2 diabetes (T2D) and obesity. Methods Using the 2017 to 2023 Merative™ claims database, we identified adult patients with severe obesity and T2D who were treated with a RYGB or GLP-1 RAs. Patients with RYGB had no treatment with GLP-1 RAs, and those who received GLP-1 RA therapy with tirzepatide or semaglutide for ≥ 2 years had no metabolic and bariatric surgery (MBS) procedures. The study cohorts were matched on demographics including obesity, associated medical problems, and baseline direct or out-of-pocket (OOP) costs to patients in the year prior to treatment initiation. Direct costs included those from outpatient services, inpatient admissions, and outpatient prescription filled that were paid directly by patients. We compared this cost up to two years after treatment initiation using paired t-tests. Results 1012 matched RYGB and GLP-1 RA patients were analyzed, including 35% male. At 1-year after treatment initiation, healthcare costs paid directly by patients were similar for the RYGB ($2,301) and GLP-1 RA ($2,179) (delta = $122, p = 0.15) cohorts. From one to two years after index treatment date, OOP costs were significantly lower in the RYGB treatment group ($1,277 vs. $2,104, p < 0.01). Two years after treatment initiation, RYGB patients spent $704 less in OOP costs than similar patients treated with GLP-1 RA medications (p < 0.01). Conclusions Direct OOP healthcare costs were lower for RYGB compared to GLP-1 RA use patients 2-years after treatment initiation.

Objective: To determine out-of-pocket (OOP) costs 2 years after sleeve gastrectomy (SG) or initiating Ozempic for patients with type 2 diabetes (T2D) and obesity. Background: Individuals with obesity and T2D have a variety of treatment options. The risks and benefits of these treatment options are becoming more well-documented; however, the real-world patient costs of these options are not known. Methods: Adults with body mass index of 35 kg/m2 or higher and T2D who had an SG or used Ozempic were identified in the employer-based retrospective claims database Merative (previously Truven IBM Marketscan) from 2017 to 2021. SG cohort was defined as having an SG (without filling a prescription for Ozempic), and the Ozempic cohort was defined as continuously filling a prescription for Ozempic for at least 2 years (and not having any bariatric surgery). Individuals in each cohort were 1:1 propensity matched on demographics, obesity-related comorbidities, and baseline OOP costs. in the year before treatment. OOP costs were compared in the 2 years after treatment using paired t tests. Results: A total of 302 SGs were matched to 302 Ozempic patients (mean age: 50, mean baseline body mass index: 40, 41% males). OOP health care costs were similar for the SG ($2267) and Ozempic ($2131) cohorts 1 year after the index date (difference = $136, P = 0.19). OOP health care costs were significantly lower in the SG cohort ($1155 vs $2,084, P < 0.01) 2 years after the index date. Conclusions: Within 2 years of starting treatment, OOP health care costs were significantly lower among individuals who had a SG versus those treated with Ozempic.