August 2016 Vol 9, Special Issue: Payers' Perspectives in Oncology - Value in Oncology
Chase Doyle

The cost of care varies widely across breast cancer chemotherapy regimens, even among treatments of comparable efficacy, according to a retrospective study presented at ASCO 2016. Some of the most costly regimens, such as docetaxel plus doxorubicin and cyclophosphamide, were found to be the most expensive and were associated with the highest risk for hospitalization.

Understanding the costs of care may be particularly relevant for patients who can choose among several guideline-concordant adjuvant chemotherapy regimens of similar efficacy, suggested Sharon H. Giordano, MD, MPH, Department Chair, Department of Health Services Research, M.D. Anderson Cancer Center, Houston, TX.

“Patients have substantial out-of-pocket costs, particularly on high-deductible health plans. Providers and patients need greater access to information about cost of care to promote treatment that is aligned with patients’ goals and preferences,” Dr Giordano said.

Out-of-Pocket Costs

Spending on cancer care grew to $125 billion in 2010 and is estimated to reach $158 billion by 2020. At the same time, patients’ out-of-pocket costs have been rapidly increasing. Although the Institute of Medicine recommends providing patients with information on the cost of care, the available data are limited, Dr Giordano emphasized.

Using a MarketScan database, Dr Giordano and colleagues retrospectively analyzed data for 14,643 women aged ≥18 years who had been diagnosed with breast cancer between 2008 and 2012. All patients received chemotherapy within 3 months of diagnosis and had full coverage 6 months before and at least 18 months after diagnosis.

The patients were divided into 2 groups based on their chemotherapy regimens: those who received a regimen without trastuzumab (N = 11,209) and those whose regimen included trastuzumab (N = 3434). Chemotherapy-related toxicity, as well as total and out-of-pocket costs were calculated using claims data.

Among those receiving a non–trastuzumab-based regimen, the median insurance payment was $82,260, and the median out-of-pocket patient cost was $2724. Among those receiving a trastuzumab-based regimen, the median insurance payment was $160,590, and the median out-of-pocket cost was $3381.

Among patients whose regimen did not include trastuzumab, 25% paid >$4712 per person, and 10% paid >$7041. By comparison, of the patients who received trastuzumab, 25% paid >$5604 per person, and 10% paid >$8384.

In addition, patients with high-deductible health plans (1.8%) had higher out-of-pocket costs, with a median of >$5000 per person. Of these patients, 25% paid ≥$8128, and 10% paid ≥$11,344 per person.

Although the costs of breast cancer chemotherapy varied widely across regimens, out-of-pocket costs did not, but the costs were substantial for patients with high-deductible health plans.

Dr Giordano acknowledged that the costs of newer drugs, such as pertuzu­mab, were not evaluated in the analysis, and the 18-month timeframe for insurance was not sufficient to estimate the total costs of breast cancer care.

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Last modified: August 19, 2016
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