Breast cancer: Similarly effective treatments vary in cost

The cost of chemotherapy treatment for breast cancer can vary widely, and higher cost does not necessarily mean greater effectiveness. These are the findings of a new study published online in Cancer and presented at the 2016 American Society of Clinical Oncology Annual Meeting in Chicago, IL.

If patients and doctors understand the costs of therapy, they can have more informed discussions when choosing a solution.

According to the American Cancer Society, 246,660 new cases of invasive breast cancer are expected to be diagnosed this year. At least 35 percent of patients will undergo chemotherapy alongside either surgery or radiation.

Researchers from the University of Texas M.D. Anderson Cancer Center examined the insurance claims of 14,643 American women who were diagnosed with breast cancer between 2008-2012.

All the participants were fully covered by insurance for a 2-year period, from 6 months before diagnosis to 18 months after. They all had chemotherapy within 3 months of diagnosis. None of the women had a secondary malignancy during the 12 months after diagnosis.

Higher median costs with trastuzumab

The authors, led by Dr. Sharon Giordano, chair of Health Services Research and professor of Breast Medical Oncology, looked at the average total and out-of-pocket cost in 2013 dollars.

Fast facts about breast cancer

  • 1 in 8 women in the U.S., or 12 percent, are expected to develop breast cancer at some time
  • Around 40,450 women are predicted to die of breast cancer in 2016
  • Some 2.8 million American women currently live with a history of breast cancer.

Learn more about breast cancer

A separate analysis compared the cost of treatment with and without trastuzumab. Trastuzumab targets the HER2 protein that is overexpressed in some kinds of breast cancer cell.

Results show that, even among similarly effective chemotherapy treatments, costs varied significantly, and that some women are paying high out-of-pocket costs for their care.

When treatment did not involve trastuzumab, insurers paid a median rate of $82,260. Costs to insurers varied by up to $20,354, compared with the most commonly used treatment. Median out-of-pocket costs were $2,727, but 1 in 4 patients paid over $4,712, and 1 in 10 paid over $7,041.

When treatment involved trastuzumab, the median cost to insurers was $160,590. Compared with the most commonly used treatment, costs were up to $46,936 different. The median cost for out-of-pocket payments was $3,381. One in 4 patients paid more than $5,604, and 1 in 10 paid $8,384.

Dr. Giordano expresses concern about the rising costs of cancer care and the financial burden on patients. She urges oncology providers to discuss the costs of care with patients, and to "move toward the goal of providing high-value care that is aligned with our patients' goals and preferences."

Need for discussion to help patients choose the best option

Dr. Giordano hopes the findings will raise awareness of the high costs of treatment, so that physicians can work more effectively with patients to help them to find the best option.

"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. 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."

Dr. Sharon Giordano

Limitations of the study include the fact that it focused on younger women with private health insurance. Those without private insurance may have to pay significantly more.

The study did not include the costs of newer therapies, and some claims may have included misclassifications. There was also no information on tumor types, stage of disease, and patient ethnicity.

Read about how, contrary to previous findings, working night shifts may not raise breast cancer risk.

    Estimating regimen-specific costs of chemotherapy for breast cancer: Observational cohort study, Sharon H. Giordano et al., Cancer, doi: 10.1002/cncr.30274, published online 10 October 10, 2016.

    University of Texas M.D. Anderson Cancer Center news release, accessed 7 October 2016

    Additional source: American Cancer Society, What are the key statistics about breast cancer?, accessed 7 October 2016.

    Additional source: Breast Cancer.org, U.S. breast cancer statistics, accessed 7 October 2016.