Cost implications of early treatment discontinuation in cancer: a real-world data analysis

Background Health care costs are rising due to increasing cancer incidence and the expanding use of high-cost anticancer medicines. Early treatment discontinuation (ETD) may signal inefficiencies in medicine use or reflect appropriate or inevitable clinical decisions. Despite its clinical and economic relevance, national-level data on ETD remain limited. This study aims to quantify ETD rates and associated costs for the highest budget anticancer medicines in the Netherlands and assess trends from 2018 to 2022. Methods We performed a retrospective analysis using real-world data from the Dutch national claims database. ETD was defined as treatment discontinued within 90 days. The study focused on the 30 highest-budget impact anticancer medicines in 2022, assessing ETD rates, related medicine costs, and trends over 5 years (2018-2022). Results In 2022, these medicines accounted for €783 million in expenditures, with ETD representing 9.9% (€77 million). Among 30 343 treatments, 29.7% (9025) were discontinued within 90 days. From 2018 to 2022, total medication costs increased by 27.1%, while ETD costs rose by 9.6%. ETDs increased from 7287 to 9025 (+23.9%), with substantial variation among medicines. For most medicines, survivors accounted for most ETD spending, while ETD followed by death remained 9%. Conclusions Approximately 30% of anticancer treatments are discontinued early, accounting for nearly 10% of medicine costs. While ETD highlights opportunities to improve efficiency, it also includes clinically justified and unavoidable discontinuations. Efforts to reduce avoidable ETD through improved patient selection, toxicity prediction, and treatment optimization are essential for more rational and equitable use of high-cost anticancer therapies.