Breast Cancer Chemotherapy Costs Vary Wildly

Informed choices of therapy regimens could save up to $1 billion annually in cancer drug spending.

A significant difference in costs was found among various breast cancer chemotherapy regimens during a recent study.

The American Cancer Society estimated that in the United States, 246,660 new cases of invasive breast cancer will be diagnosed in 2016. However, by choosing regimens that are both equally effective and less costly, it could impact the national cost of breast cancer care by $1 billion each year.

“The costs of cancer care have been increasing dramatically, both for the health care system and for patients,” said researcher Sharon Giordano, MD. “As physicians, we increasingly are recognizing the financial burden on our patients. 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.”

For the study, researchers analyzed claims of 14,643 adult women diagnosed with breast cancer between 2008 and 2012 from the MarketScan database.

Participants were required to have full insurance coverage for 6 months prior to 18 months after diagnosis, to have received chemotherapy within 3 months of diagnosis, and to have had secondary malignancy within 1 year of diagnosis in order to be eligible for the study.

All claims within 18 months of diagnoses, normalized to 2013 dollars, were used to calculate adjusted average total and out-of-pocket costs. A separate analysis was performed for regimens that included trastuzumab and those that did not.

“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.

However, the most significant variations were found in a comparison of insurer costs. Patients who were not given trastuzumab had median insurance payments of $82,260, which could vary by as much as $20,354 relative to the most common regimen. The median out-of-pocket cost was $2727, with the largest variation being $382.

The median insurance payments for patients who received trastuzumab-based therapies was $160,590, with a difference of $46,936 relative to the most common regimen. The median out-of-pocket cost was $3381 with relative differences of $912.

“When considering all patients, we did not see large variations in out-of-pocket costs across different chemotherapy regimens, but some individuals did have high out-of-pocket costs,” Giordano said. “Patients who were enrolled in high-deductible health plans had median out-of-pocket payments of over $5000.”

Some limitations to the study included the primary focus on a younger population with private insurance, the inability to include newer therapy costs, and the reliance on insurance claims that could include misclassifications.

Giordano also noted that they were unable to use cancer registry data to analyze patient race or ethnicity, tumor characteristics, or cancer stage. Further research will be conducted as future data becomes available.

“Oncology providers need to continue to move toward the goal of providing high value care that is aligned with our patients' goals and preferences,” Giordano said. “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.”