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Cancer treatment costs can vary widely


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Healthcare providers cannot give their breast cancer patients information on chemotherapy treatment costs because not enough is known about the exact costs. New research finds that costs vary not only between different cancer treatments, but also between similar treatments, such as all treatments that target HER2+ breast cancer. (11/22/16)


STUDY AT A GLANCE

This study is about:

The costs associated with different breast cancer treatments.

Why is this study important?

Cost is an unfortunate but important factor for patients when deciding on a treatment regime. Even patients who have insurance may have high out-of-pocket costs. Healthcare providers want to give their patients the best treatments possible and patients want these treatments, but what if that is something patients can’t afford?  Previous research established a link between high costs of cancer care and lower adherence to medications, and increased risk of bankruptcy as well as psychological and material difficulties. Additionally, while healthcare providers know that communicating treatment costs is important for patients, it does not often occur because cost information is simply not available.

Study findings: 

  1. The median insurance payment for patients who have private insurance and received one of the trastuzumab (Herceptin)-based treatments (the targeted therapy for HER2+ breast cancer) was $160,590. The median out-of-pocket payment was $3,381. This means that about half of the patients paid more than $3,381 and about half paid less.
    • 25% of patients paid more than $5,604 out-of-pocket and 10% paid more than $8,384 out-of-pocket.
  2. The median insurance payments for patients who have private insurance and received one of the non-trastuzumab treatment (for patients with HER2- breast cancer) was $82,260. The median out-of-pocket payment was $2,724. This means that half of patients paid more than $2,724 and half paid less.
    • 25% of patients paid more than $4,712 out-of-pocket and 10% paid more than $7,041 out-of-pocket.

What does this mean for me?

This study suggests that breast cancer treatment costs can be very different depending on the type of treatment and the patient’s insurance coverage. The authors of this study wrote, “Because of the rising costs of care and increased cost-sharing for patients, the expense of treatment is becoming more relevant to patients and their families, and providers need more accessible information to be able to answer patients’ questions about the financial impact of their treatment choices.” More work needs to be done so healthcare providers can have this information for their patients.

Questions to ask your health care provider:

  • What is this treatment estimated to cost me?
  • I am having trouble affording my treatment costs; what can I do?

IN DEPTH REVIEW OF RESEARCH

Study background:

Cost of treatment is an important subject that many patients want their healthcare providers to address. This is especially important for patients who have the choice between similar treatment options. HER2+ and HER2- breast cancer patients have quite a few options to choose from—the National Comprehensive Cancer Network guidelines identify 12 acceptable chemotherapy regimens for HER2- breast cancer patients and 9 acceptable chemotherapy regimens for HER2+ breast cancer patients. Unfortunately, not a lot of cost information is available for healthcare providers to share with their patients to help them with these decisions.

Sharon Giordano and colleagues from The University of Texas MD Anderson Cancer Center published work in 2016 in the journal Cancer to get a better idea of breast cancer treatment costs for breast cancer patients.     

Researchers of this study wanted to know:

What are the costs for U.S. breast cancer treatment from both the insurance companies’ and patients’ perspective?

Population(s) looked at in the study:

The 14,643 women in this study were 18-years-old or older and had breast cancer diagnosed between 2008 and 2012. About 24% received therapy that included the trastuzumab (Herceptin), a targeted therapy for HER2+ cancer, while 77% received non-trastuzumab regimens including taxanes such as docetaxel, platinum-based drugs such as carboplatin, and anthracyclines.  Women in the study also had surgery, and, where appropriate, hormone therapy.  All women in the study had private insurance and received treatment within 3 months of diagnosis. Costs were evaluated for up to 18 months after diagnosis.

Study findings: 

  1. The median insurance payments for patients who have private insurance and received one of the trastuzumab-based treatment (the chemotherapy for HER2+ breast cancer) was $160,590. The median out-of-pocket payment was $3,381.
    • 25% of patients paid more than $5,604 out-of-pocket and 10% paid more than $8,384 out-of-pocket.  This means that about half of the patients paid more than $3,381 and about half paid less.
  2. The median insurance payments for patients who have private insurance and received one of the nontrastuzumab treatment (for patients with HER2- breast cancer) was $82,260. The median out-of-pocket payment was $2,724. This means that about half of the patients paid more than $2,724 and about half paid less.
    • 25% of patients paid more than $4,712 out-of-pocket and 10% paid more than $7,041 out-of-pocket.
  3. Costs varied within similar therapy regimens. For example, for patients who received a trastuzumab-based treatment, the median insurance payment costs differed by about $20,000.

Limitations:

This study does not include information on patients without insurance—these patients face considerably higher out-of-pocket costs.

Because this study used an 18-month time frame, the researchers could not estimate total costs of breast cancer care. For example, patients who underwent breast reconstruction beyond the 18-month window or may have received hormone therapy for 5-10 years. And because the source data used for this study were not linked to any cancer registry data, researchers were unable to look at the patients’ cancer stage, race/ethnicity or tumor characteristics.

Finally, the researchers were unable to look at newer drugs that have been released since the data was collected.                       

Conclusions:

This study suggests that breast cancer chemotherapy costs vary widely. More work needs to be done so healthcare providers can provide patients with accurate cost information. Until this happens, patients should have frank discussions with their healthcare providers about cost and how it will affect them.

Posted 11/22/16

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References

Giordano SH, Niu, J, Chavez-MacGregor M, et al. “Estimating Regimen-Specific Costs of Chemotherapy for Breast Cancer: Observational Cohort Study.” Cancer. Published online first on October 10, 2016. 

Related Information and Resources

FORCE  Information:  Paying for Cancer Treatment

FORCE Information: Health Insurance Appeals 

Be Empowered Webinar: Hereditary Cancer, Insurance, and Your Legal Rights (2015) 

FORCE XRAYS: Financial Burden Affects Quality of Life for Breast Cancer Survivors 

 

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