Real-world treatment patterns, healthcare resource utilization, and costs associated with high-risk endometrial cancer in England: a retrospective cohort study

OBJECTIVES: To describe real-world treatment patterns, healthcare resource utilization (HCRU), and hospital-based non-drug direct medical costs of patients with high-risk endometrial cancer (HR-EC) from initiation of first adjuvant therapy in England. METHODS: England's National Cancer Registration and Analysis Service. Treatment patterns, annual rates of HCRU, and non-drug direct medical costs (in 2022 £) were described from the first adjuvant therapy. RESULTS: In total, 6,036 women (mean age: 67 years, 86% White) were included. The most commonly prescribed adjuvant therapy was radiation therapy (43%), followed by chemoradiotherapy (37%), and systemic chemotherapy (19%). Across the first four lines of therapy, there were 80 unique treatment sequences. The majority of patients (79%) did not receive further treatment after the adjuvant therapy. Amongst those that did, the most common treatment across all subsequent lines was systemic chemotherapy. In the total cohort, the mean annual rate of inpatient, outpatient, and A&E visits was 2.8, 12.5, and 1.0, respectively, corresponding to a mean non-drug direct medical cost per year of £4,581. Patients who experienced recurrence exhibited higher HCRU and costs over follow-up, reflecting overall healthcare utilization trajectories among patients who ultimately recurred rather than costs directly attributable to recurrence. CONCLUSIONS: Our study provides novel insights into the real-world treatment patterns, HCRU, and non-drug direct medical costs associated with HR-EC in England. The substantial clinical and economic burden underscores the need for ongoing research and optimization of treatment strategies.