ArticleClinical drug investigation2026
Healthcare Cost Patterns in CDK4/6 Inhibitor-Treated HR+/HER2- Metastatic Breast Cancer.
Article in Clinical drug investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesCyclin-dependent kinase 4/6 inhibitors (CDK4/6i) are standard first-line treatment for hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer, yet the cost architecture across the full treatment trajectory remains poorly characterized. This study aimed to characterize phase-specific healthcare costs using a Japanese nationwide claims database.
methodsWe conducted a retrospective cohort study using the DeSC-IQVIA integrated Claims data (April 2014-May 2025). Patients with HR+/HER2- metastatic breast cancer who initiated first-line CDK4/6i were identified. Healthcare costs were decomposed into drug, non-drug inpatient, and non-drug outpatient components across eight treatment phases. Death-anchored analysis evaluated cost structure over the final 12 months of life among decedents.
resultsAmong 5435 patients (median age 72.3 years), active treatment phases showed drug-dominated cost structures: first-line per-patient per-month (PPPM) cost was 482,936 Japanese yen (JPY) (drug 85%-90%), second-line 361,615 JPY (81%), and extended chemotherapy 255,922 JPY (66%). A marked inversion occurred in the palliative phase (PPPM 233,824 JPY; drug 11%, inpatient 70%) and terminal phase (PPPM 412,149 JPY; drug 17%, inpatient 69%). Death-anchored analysis of 1111 decedents identified a transition 2 months before death, when inpatient costs first exceeded drug costs. Individual fixed-effects models estimated the CDK4/6i-associated cost increment at 239,815 JPY/month (p < 0.001), corresponding to a total treatment-associated cost of 2.99 million JPY per patient.
conclusionsThe cost architecture of CDK4/6i-treated metastatic breast cancer follows a predictable trajectory from drug-dominated active treatment to hospitalization-dominated end-of-life care, with a structural transition approximately 2 months before death. These findings support phase-specific healthcare resource allocation and economic modeling.
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