Evaluating Costs Related to Breast Cancer Chemotherapy

Estimates for the costs of treating breast cancer vary considerably, depending on patient population, time horizon, methodology, and other variables. According to a recent review by Campbell and Ramsey¹ from the Fred Hutchinson Cancer Research Center in Seattle, estimates of lifetime per patient costs associated with breast cancer ranged from $20,000 to $100,000. As a result of the relatively long survival of patients with breast cancer, the costs of continuing care account for the largest proportion of lifetime costs.

Presented below are highlights from recent studies on the costs associated with breast cancer.

Costs associated with lymphedema. Shih and colleagues² from the University of Texas M. D. Anderson Cancer Center in Houston analyzed claims data from 1877 women of working age who had breast cancer. About 10% of the patients had claims related to the treatment of lymphedema. The risk factors for lymphedema included full axillary node dissection and chemotherapy.

Medical costs were significantly higher-by $14,877 to $23,167-in breast cancer patients who had lymphedema than in those without lymphedema. The increased costs were predominantly associated with outpatient care, which in some cases involved various forms of physical therapy; the treatment of infections, such as cellulitis and lymphangitis; and mental health services, including the treatment of depression.

Insurance companies do not always cover the costs of treating lymphedema, and Shih and colleagues note that the use of claims data may underestimate the true incidence of this complication of breast cancer.

The relative costs of capecitabine versus taxanes for first-line chemotherapy. Camacho and associates³ analyzed the relative costs of first-line chemotherapy with capecitabine versus taxanes in women with metastatic breast cancer. They found that total costs in the preindex year were significantly lower among patients starting taxanes than among those starting capecitabine (mean, $20,042 vs $35,538). However, in the postindex year, health care use and associated costs were significantly higher for those receiving taxanes ($43,353 vs $35,842).

These differences were largely attributable to lower expenses in chemotherapy-related claims and fewer visit days to outpatient settings for patients receiving capecitabine. After adjusting for propensity scores and other confounding variables, the analysis showed that treatment with capecitabine was associated with 32% lower health care costs, compared with taxane treatment.

Cost-effectiveness of pegfilgrastim and filgrastim for prophylaxis against febrile neutropenia. Lyman and colleagues⁴ compared the incremental cost-effectiveness of pegfilgrastim and filgrastim as primary prophylaxis against febrile neutropenia (FN) in women receiving myelosuppressive chemotherapy for early-stage breast cancer. Their decision analysis model incorporated a health care payer’s perspective with a lifetime study horizon and addressed direct medical costs and outcomes related to the reduced incidence of FN and potential survival benefits.

They found that pegfilgrastim was cost-saving and more effective than 11-day filgrastim. The incremental cost-effectiveness ratio for pegfilgrastim versus 6-day filgrastim was $12,904 for each avoided episode of FN. Adding the survival benefit that was associated with reduced FN-related mortality and receipt of optimal chemotherapy (on-time receipt of full-dose chemotherapy) yielded an incremental cost-effectiveness ratio of $31,511 and $14,415 per quality-adjusted life-year gained, respectively.

Cost-effectiveness of ixabepilone plus capecitabine. Reed and associates⁵ compared the cost-effectiveness of ixabepilone plus capecitabine with capecitabine alone in patients who had metastatic breast cancer that was thought to be taxane-resistant and who previously had been treated with or were resistant to an anthracycline. The investigators’ decision analysis model represented data collected in a trial on medical resource use, health-related quality of life, and clinical outcomes.

Overall survival was significantly associated with the level of tumor response. Total costs were an estimated $60,900 for patients receiving ixabepilone plus capecitabine and $30,000 for those receiving capecitabine alone. Therapy with ixabepilone was associated with estimated gains of 1.96 months in life expectancy and 1.06 months in quality-adjusted survival. The incremental cost-effectiveness ratio was $359,000 per quality-adjusted life-year.

References
1. Campbell JD, Ramsey SD. The costs of treating breast cancer in the US: a synthesis of published evidence. Pharmacoeconomics. 2009;27:199-209.
2. Shih YC, Xu Y, Cormier JN, et al. Incidence, treatment costs, and complications of lymphedema after breast cancer among women of working age: a 2-year follow-up study. J Clin Oncol. 2009;27:2007-2014.
3. Camacho FT, Wu J, Wei W, et al. Cost impact of oral capecita-bine compared to intravenous taxane-based chemotherapy in first-line metastatic breast cancer. J Med Econ. 2009;12:238-245.
4. Lyman GH, Lalla A, Barron RL, Dubois RW. Cost-effectiveness of pegfilgrastim versus filgrastim primary prophylaxis in women with early-stage breast cancer receiving chemotherapy in the United States. Clin Ther. 2009;31:1092-1104.
5. Reed SD, Li Y, Anstrom KJ, Schulman KA. Cost effectiveness of ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol. 2009;27:2185-2191.