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Breast Cancer Drug Costs Vary Among Insured Patients

Breast cancer clinic

(M.D. Anderson Cancer Center)

10 October 2016. Women receiving chemotherapy for breast cancer can face widely different costs for their treatments, regardless of effectiveness, even if they have health insurance. The findings of a research team from M.D. Anderson Cancer Center in Houston that reviewed these costs appear in today’s issue of the journal Cancer (paid subscription required).

Breast cancer remains among the leading cause of cancer death among women, second to lung cancer. American Cancer Society estimates some 247,000 individuals will be diagnosed with invasive breast cancer in 2016, leading to more than 40,000 deaths. Beginning in 2000, occurrences and deaths from breast cancer began leveling off and falling, attributed to a reduction in hormone therapy after menopause and more early detection.

Despite reductions in the number of cases, the cost of cancer care continues to rise, often causing a burden to patients, families, and health systems, yet physicians find it difficult to advise patients on the relative cost of care, since reliable data about costs is difficult to pin down. The team led by Sharon Giordano, chair of health services research at M.D. Anderson, part of the University of Texas system, sought to generate real-world cost estimates for different breast cancer chemotherapy treatments, at least for patients with private health insurance.

Giordano and colleagues sampled private health insurance claims data from the MarketScan database for individuals diagnosed with breast cancer between 2008 and 2012, who showed no secondary malignancy in a year after diagnosis, and received chemotherapy with 3 months of diagnosis. That sample yielded 14,463 cases. The researchers also calculated total and out-of-pocket costs, adjusted for inflation in 2013 dollars.

“In this study,” says Giodarno in an M.D. Anderson statement, “we found substantial variation in the costs of breast cancer treatment for different chemotherapy regimens, even when comparing treatments of similar efficacy.” Patients receiving the chemotherapy drug trastuzumab, marketed as Herceptin by Genentech, were charged, before insurance, a median amount of $160,590 for their treatments, compared to $82,260 for individuals receiving other chemotherapy drugs.

Median out-of-pocket costs — expenses not covered by insurance — for trastuzumab patients were $3,381, more than the $2,724 for patients receiving other drugs. But even for these insured patients, the out-of-pocket costs of their treatments could vary widely. One in 10 trastuzumab patients had to pay more than $8,384 of their own money, while 1 in 10 individuals receiving drugs other than trastuzumab paid more than $7,041 from their own funds.

Another key factor was the type of health insurance carried by the patients. Among individuals with high-deductible health plans, patients receiving trastuzumab treatments paid a median of $5,158 out-of-pocket, with 1 in 10 people in this group paying $11,344 or more of their own money.

The authors note some limitations of their study, notably the focus on younger (pre-Medicare) patients with private insurance, since uninsured patients may face significantly higher costs of care. In addition, newer types of targeted therapies were not included in the analysis. Nonetheless, Giordano hopes “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.”

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