Costs of Breast Cancer Chemotherapy Regimes Differ Greatly in US, Study Reports

Costs of Breast Cancer Chemotherapy Regimes Differ Greatly in US, Study Reports

The cost of chemotherapy regimes for breast cancer (BC)  vary greatly in the United States, regardless of proven effectiveness, a University of Texas (UT) MD Anderson Cancer Center study reported.

It advises physicians and patients to consider cost differences when choosing among chemotherapy options of similar efficacy — potentially lowering annual breast cancer care costs nationwide by as much as $1 billion.

The findings, part of a poster presentation at the June meeting of the American Society of Clinical Oncology (ASCO)  in Chicago, were published recently online in the journal Cancer, in an article titled, “Estimating regimen-specific costs of chemotherapy for breast cancer: Observational cohort study.”

“The costs of cancer care have been increasing dramatically, both for the health care system and for patients. As physicians, we increasingly recognize the financial burden on our patients,” Sharon Giordano, MD, lead author of the study and chair of Health Services Research and professor of Breast Medical Oncology, said in a press release. “Both physicians and patients need greater access to information about the treatment costs so this critical issue can be discussed during a patient’s decision-making process.”

“This is especially relevant for breast cancer care, for which numerous guideline-concordant adjuvant chemotherapy regimens exist,” the researchers wrote.

The American Cancer Society estimates that 246,660 new cases of invasive BC will be diagnosed in the U.S. this year. At least 35 percent of all breast cancer patients are usually treated with chemotherapy in addition to surgery or radiation, the researchers said, impacting treatment costs.

Researchers, using the MarketScan database, analyzed claims from 14,643 adult women diagnosed with breast cancer between 2008 and 2012, who had full insurance coverage from six months before to 18 months after their diagnosis, received chemotherapy within three months of diagnosis, and with no secondary malignancy for one year after diagnosis.

They assessed adjusted average total and out-of-pocket costs within 18 months of diagnosis (in 2013 dollars), doing a separate analysis for chemotherapy regimens that did or did not include Herceptin (trastuzumab).

Results showed that, among patients treated with Taxotere (docetaxel) and Cytoxan  (cyclophosphamide):

  • Median insurance payments averaged $82,260 (and varied by a maximum of $20,354, relative to standard regimen).
  • Median out-of-pocket costs averaged $2,727, but 25 percent of patients paid over $4,712, and 10 percent paid over $7,041.

For patients who received Herceptin plus Taxotere and Paraplatin (carboplatin):

  • Median insurance payments averaged $160,590 (with a difference of up to $46,936 relative to the standard regimen).
  • Median out-of-pocket costs averaged $3,381 (25 percent of patients paid over $5,604, and 10 percent paid over $8,384).

“I hope this study will make providers more aware of the substantial financial burden associated with chemotherapy treatments so they may work with their patients to identify the best options available,” Giordano said.

The team plans further research into the respective value of different cancer care options.

Study limitations identified by the researchers include that its data covered mostly younger populations with private health insurance; patients without private insurance likely pay significantly higher costs for care. In addition, researchers could not include the costs of more recent therapies. The study also relied on claims from the insurance companies, which may have some misclassifications, and did not use cancer registry data to assess cancer stage, tumor characteristics, or patient race or ethnicity.