Study Finds Significant Cost Differences Among Breast Cancer Chemotherapy Regimens

Informed choice of chemotherapy could reduce costs of breast cancer care by $1 billion annually

Costs associated with different breast cancer chemotherapy regimens can vary significantly regardless of effectiveness, according to new research from the University of Texas MD Anderson Cancer Center. Understanding cost differences can help guide informed discussions between patients and physicians when considering chemotherapy options.

The findings were published online in Cancer.

“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,” said lead author Sharon Giordano, MD. “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.”

The American Cancer Society has estimated that 246,660 new cases of invasive breast cancer will be diagnosed in the United States in 2016. At least 35% of patients with breast cancer receive chemotherapy in addition to surgery or radiation. Therefore, choosing equally effective but less-costly regimens could reduce the costs of breast cancer care nationally by $1 billion every year, according to Giordano.

To calculate the cost of care, the researchers analyzed claims from the MarketScan database of 14,643 adult women diagnosed with breast cancer between 2008 and 2012 in the U.S. To qualify for the study, women must have had full insurance coverage from six months prior to 18 months after diagnosis; must have received chemotherapy within three months of diagnosis; and must have had no secondary malignancies within one year of diagnosis.

The researchers calculated adjusted average total and out-of-pocket costs using all claims within 18 months of diagnoses, normalized to 2013 dollars, with separate analyses conducted for regimens that did and did not include trastuzumab (Herceptin, Genentech).

“In this study, we found substantial variation in the costs of breast cancer treatment for different chemotherapy regimens, even when comparing treatments of similar efficacy,” Giordano said.

The largest variations were seen when the researchers compared insurer costs. For patients who did not receive trastuzumab, median insurance payments were $82,260 and varied by as much as $20,354 compared with the most common regimen. Median out-of-pocket costs were $2,727, but 25% of patients paid more than $4,712, and 10% paid more than $7,041.

For patients receiving trastuzumab-based therapies, median insurance payments were $160,590, with a difference of as much as $46,936 compared with the most common regimen. Median out-of-pocket costs were $3,381, with 25% of patients paying more than $5,604, and 10% paying more than $8,384.

The study was limited by its focus on a younger population with private health insurance, according to Giordano. Patients lacking private insurance may face significantly higher costs of care. In addition, the researchers were unable to include the costs of newer therapies in the current study. Finally, the study relied on insurance claims, which may include misclassifications, and was not able to use cancer registry data to analyze cancer stage, patient race or ethnicity, or tumor characteristics.

“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 Giordano. “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.”

Source: University of Texas MD Anderson Cancer Center; October 10, 2016.