Reducing the Cost of Breast Cancer Treatment by $1 Billion

Health plan variations, as well as site of treatment, are a huge influence on how much a patient pays out of pocket (OOP). Now, a retrospective study in breast cancer patients suggests that patients, especially those enrolled in high-deductible plans, can lower their OOP burden by speaking with their oncologist about alternate treatments that may be equally effective and understanding the drug coverage policy of their insurance plan.

For the study, published in the journal Cancer, the authors identified 14,643 women from the MarketScan database who were diagnosed with incident breast cancer between 2008 and 2012 and received chemotherapy within3 months of diagnosis. There were no secondary malignancies identified in these women during a 1-year period following their primary tumor diagnosis.

On the financial front, total insurance costs and OOP costs for these patients were estimated using claims within 18 months of diagnosis (normalized to 2013 dollars). The authors found that use of trastuzumab (Herceptin)—which targets the HER2 receptor—in the treatment plan resulted in significantly higher, and variable, treatment costs.

“The high costs of care may leave some patients unable to pay their medical bills or afford their potentially life-saving medications,” Sharon Giordano, MD, MPH, lead author of the study, told Reuters.

Treatments that included trastuzumab, the authors report, cost insurance companies a median of $160,590; the median OOP expenditure for the patients was $3381. The insurance costs dropped significantly if patients did not receive trastuzumab: $82,260 was the median total cost of care, and patients paid a median $2724. A majority (75%) of patients who did not receive trastuzumab paid less than $4712; 25% paid more than $4712 and 10% paid more than $7041. However, 25% of patients who received trastuzumab paid more than $5604 and 10% paid more than $8384.

Patients enrolled in high-deductible plans had a significant OOP burden with a median payment of $5158, while 25% paid at least $8128, and 10% ended up paying more than $11,000.

Giordano estimates that informing women about equally effective but less expensive regimens could reduce treatment costs for breast cancer in the United States by $1 billion.

The authors identify 3 important limitations of their study:

• The study population was younger women with private health insurance
• Claims data was used, which may not account for stage at diagnosis or tumor characteristics
• Newer breast cancer treatments were not included when estimating treatment costs

An epidemiologist at the University of North Carolina at Chapel Hill, Stacy Dusetzina, PhD, told Reuters, “There may be alternative treatments that have lower costs or that your insurer covers more generously,” and patients have the option to seek these alternatives by speaking to their oncologist and understanding their insurance coverage.

Reference

Giordano SH, Niu J, Chavez-MacGregor M, et al. Estimating regimen-specific costs of chemotherapy for breast cancer: Observational cohort study [published online October 10, 2016]. Cancer. doi: 10.1002/cncr.30274.