Stockholm, Sweden—The cost of cancer therapies is a growing concern not only for patients but also for providers and payers. Addressing the cost burden for those involved in cancer care is becoming a priority that cannot be avoided with the growing role of targeted therapies in oncology.
A study presented by Melissa Brammer, MD, Medical Director, Genentech, San Francisco, CA, shows that complications associated with treating cancer essentially double the cost of treating metastatic breast cancer.
The treatment of metastatic breast cancer varies from $3000 to $8000 per patient per month, but treating the complications that are associated with the cancer treatment adds another $3000 to $4000 to the total cost of therapy, according to Dr Brammer. She reported the results of her study at the 2011 European Multidisciplinary Cancer Congress.
“Incremental costs of treating adverse events should be considered in evaluating new therapies. There is a need for treatments that are effective, but do not incur significant toxicities,” Dr Brammer suggested.
She and her coinvestigators used the PharMetrics Integrated Database (2004-2009) to select patients with metastatic breast cancer who were treated with chemotherapy and/or agents targeting HER2.
They identified episodes of treatment with single-agent or combination therapies for a course of at least 30 days. They determined the complications associated with treatment, using medical claims with a diagnosis for one of the following events of interest: anemia, alopecia, arthralgia, bilirubin elevation, dehydration, dyspnea, infection, leukopenia, and neutropenia.
A total of 1551 patients with 3157 eligible episodes of treatment met the inclusion criteria. The most common treatment-associated complications were anemia, bilirubin elevations, and leukopenia, with substantial variation across type of regimen, Dr Brammer reported.
Anemia was the most common event with trastuzumab (Herceptin)/ vinorelbine (Navelbine) (70%), singleagent gemcitabine (Gemzar) (70%), and vinorelbine (65%); it was least likely with capecitabine (Xeloda). Bilirubin elevations were most common with trastuzumab/vinorelbine (35%), tras tuzumab/docetaxel (Taxotere) (31%), and single-agent paclitaxel (Taxol) (31%). Leukopenia was most common with vinorelbine (46%) and trastuzumab/vinorelbine (38%). Neutropenia was most common with vinorelbine (30%) and trastuzumab/ vinorelbine (30%).
The average monthly cost per patient for treating the most expensive chemotherapy-related complications included $3200 for anemia, $3820 for dehydration, $4217 for dyspnea, and $3453 for neutropenia. Similar costs were incurred when these side effects occurred with anti-HER2 agents.
The cost drivers associated with anemia and neutropenia were drug ex penses, whereas dyspnea and dehydration costs were driven mostly by hospitalization expenses. The treatment-related costs in this study did not capture out-of-claims costs, such as alopecia and fatigue; therefore, the total cost of these complications is actually even higher, Dr Brammer noted.
Skeletal-related events (SREs) can lead to lengthy hospitalizations and many outpatient visits in patients with bone metastases, suggested Herbert Hoefeler, MD, of the Forschungszentrum Rhur in Witten, Germany. He presented results from a multicenter prospective observational study conducted in Europe, Canada, and the United States.
The study estimated future resourcing needs and assessed the value of new treatments to prevent SREs. Although studies have shown that SREs increase health resource utilization and cost, “there is a lack of robust, prospective data” on which to base decisions, Dr Hoefeler said. “This is the first study to examine health resource utilization associated with different types of SREs prospective ly in a large sample of patients in Europe.”
The study included 478 European patients who had bone metastases secondary to breast cancer, prostate cancer, lung cancer, or multiple myeloma, and who had at least 1 SRE within 90 days of study enrollment.
Across all tumor types and countries, 21% to 48% of SREs required inpatient stays, with an average duration of 13 to 27 days. Outpatient visits were required for 58% to 84% of SREs, with each SRE associated with a mean of 2.5 to 7.3 outpatient visits.
Hospitalization rates were similar across tumor types, but a trend toward a higher percentage was seen for lung cancer—29% to 49% (according to country) versus 20% to 29% for other tumor types.
Fewer outpatient visits were reported per SRE in the United Kingdom, which was primarily driven by greater use of single-fraction radiation. “Preventing SREs occurring in all individuals with cancer is important to substantially reduce patient burden and rate of hospitalization,” Dr Hoefeler said. “This may reduce costly health resource utilization.”
