Significant Cost Variation in Breast Cancer Chemotherapy

A study presented at the 2016 American Society of Clinical Oncology Annual Meeting (June 3-7; Chicago, IL) has found that the costs associated with different breast cancer chemotherapy regimens can vary significantly, regardless of effectiveness.

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As the costs associated with drugs and other facets of care have continued to rise, discussing the financial impact of cancer treatment has become an even more important component of care. However, a lack of adequate data has hindered some physicians from providing their patients with all the information they need to make informed decisions.

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Thus, researchers led by Sharon Giordano, MD, chair of health services research and professor of breast medical oncology at MD Anderson Cancer Center (Houston, TX), conducted a study to generate estimates of costs associated with guideline-concordant breast cancer adjuvant chemotherapy regimens.

They analyzed claims data of 14,634 women diagnosed with breast cancer between 2008 and 2012 using the Marketscan database. To be included in the study, patients had to have full medical coverage 6 months prior to 18 months after diagnosis, received chemotherapy within 3 months of diagnosis, and had no secondary malignancy within 1 month of diagnosis.

Total out-of-pocket costs were calculated using claims data within 18 months of diagnosis and normalized to 2013 dollars, with separate analyses conducted for regimens that did and did not include trastuzumab.

Researchers included a table outlining all their results of their analysis, but the most significant differences were found when comparing insurer costs. For patients who did not receive trastuzumab, median insurance payments were $82,260, but varied as much as $20,354 when compared with the most common regimen. Median out-of-pocket costs were much more consistent, with a median of $2727 and largest variation of $382.

In regimens that included trastuzumab, there was even greater variation in how costs were covered. The median insurance payments associated with treatments were $160,590, with differences as high as $46,936 relative to the most common regimen. Median out-of-pocket costs were $3381, with relative differences as much as $912.

Researchers concluded that costs associated with breast cancer chemotherapy vary widely across regimens and that patients bear a significant out-of-pocket burden.

“Oncology providers need to continue to move toward the goal of providing high-value care that is aligned with our patients' goals and preferences,” said Dr. Giordano. “I hope this study will make providers more aware of the substantial financial burden associated with chemotherapy treatments so that they may work with their patients to identify the best options available.”