Defining Value for the Treatment of Brain Metastases in Metastatic HER2-Positive Breast Cancer - Episode 14

Impact of Early Identification of Brain Mets

A payer perspective on the impact of early identification of brain mets in HER2+ metastatic breast cancer on healthcare utilization and patient outcomes as well as recommendations to other payers managing this patient population.

Bhavesh Shah, RPh, BCOP: As payers, we’re always thinking about total cost of care. Early diagnosis can prevent a patient from getting hospitalized or going to the ICU [intensive care unit]. You can imagine that, as patients are diagnosed early and their symptoms are under control, they’re going to have fewer falls, they’re going to have a lower probability of having seizures, and they’re going to have fewer VTEs [venous thromboembolisms]. The thought behind early diagnosis is preventing them from being hospitalized or having this increase in health care utilization. That also goes to the most appropriate treatment that you would use in patients that can optimize their outcome with that early diagnosis.

Every payer is going to have differences in how they manage this disease, so you have the commercial patient population, you have Medicare, and you have Medicaid. We know that the Medicaid patient population is probably the most complex patient population. They have the most barriers to access, and as we had talked about, this specifically affects patients of African American and Latino descent more aggressively. If I was a Medicaid payer, I would be more aggressive in making sure the treatments are optimized and the patients are receiving the appropriate treatment that would have long-term CNS [central nervous system] progression-free survival or overall survival for these patients.