Removing More Breast Tissue during Surgery Reduces Costs

“A 10-minute procedure to remove a little more tissue during a partial mastectomy could spare thousands of breast cancer patients a second surgery but and also cut costs by as much as $750 per patient, according to a Yale Cancer Center study.

“The findings are scheduled for presentation Dec. 10 at the 2015 Annual San Antonio Breast Cancer Symposium.

“Nearly 300,000 women in the United States are diagnosed with breast cancer each year; more than half undergo breast-conserving surgery with a partial mastectomy to remove the disease. About a third of patients who undergo this procedure have ‘positive margins,’ or cancer cells found at the edge of the removed tissue, and will require a second surgery to ensure that no cancer remains. A Yale study, published online in May in the New England Journal of Medicine, demonstrated that removing more tissue all the way around the tumor site during the initial surgery — known as cavity shave margins (CSM) — could cut the need for a second surgery in half.”


Pertuzumab Not Cost Effective in Metastatic HER2-Positive Breast Cancer

“Though the addition of pertuzumab to docetaxel and trastuzumab as first-line therapy for HER2-positive breast cancer has been shown to yield a substantial survival benefit, a new analysis shows that there is very little chance that pertuzumab would be cost effective in the United States.

“The CLEOPATRA trial showed that pertuzumab along with docetaxel and trastuzumab (THP) resulted in a median survival in HER2-positive metastatic breast cancer patients of 56.5 months, compared with only 40.8 months for the latter two drugs alone (TH). ‘These exceptional results come at a price,’ wrote researchers led by Ben Y. Durkee, MD, PhD, of Stanford University in California. ‘Our work shows that an insurer could expect to pay $4,649 per week for the THP regimen at Medicare rates. Private contractors and smaller entities would pay more.’

“The researchers used a decision-analytic Markov model to evaluate the regimen’s cost effectiveness, based on the study population from CLEOPATRA and the assumed number of patients for whom the THP regimen would be recommended in the metastatic setting. Results were published online ahead of print in the Journal of Clinical Oncology.”


Two Generic Drugs Shown to Reduce Breast Cancer Deaths

“There’s new evidence that two inexpensive generic drugs can improve survival rates for women who develop breast cancer after menopause.

“In two large studies published Friday in The Lancet, a class of hormone-therapy drugs called aromatase inhibitors and bone-preserving drugs called bisphosphonates improved survival and recurrence rates in postmenopausal women with early breast cancer.

” ‘It may be that this is a first step in helping us figure out which patients are more likely benefit and which patients are not,’ Dr. Dawn L. Hershman, associate professor of medicine and director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at Columbia University, told CBS News. ‘We can strategize to give the medications that are going to give the most benefit and avoid the toxicity and the cost for patients with minimal benefits.’ “


New Test Could Sharply Reduce Risky, Costly Lung Cancer Biopsies

“When a suspicious lesion shows up in the lungs on a CT scan, the first thing your doctor wants to know is whether it’s cancerous. A specialist will pass a long, thin bronchoscope into your airway in the hope of grabbing a few cells of the growth so they can be examined under a microscope.

“But some of these lesions or nodules are deep in the small branches of the lungs, out of reach of the bronchoscope, which is about the diameter of a pen. Other times, the results are inconclusive. That has left only two ways to determine whether the abnormality is cancerous: inserting a needle through the chest wall and into the tumor, or surgically opening a patient’s chest to find it (and remove it if necessary).

“The first procedure carries a 15 percent risk of collapsing a lung (pneumothorax), as well as infection. The second is serious surgery that requires general anesthesia and results in the loss of lung tissue. Both are in-patient procedures that carry the cost and other risks of hospitalizations. In about a third of the surgeries, the growth turns out to be benign, meaning the surgery was unnecessary.

“But now, according to a study published Sunday in the New England Journal of Medicine, there appears to be a new, much less invasive way of determining whether a growth is malignant.”


Biopsies More Costly, Less Effective in Lung Cancer Diagnosis

“Biopsies were identified as the most costly tests in lung cancer diagnosis, with negative biopsies accounting for 43.1% of total diagnostic costs, according to study findings.

“Researchers noted that decreasing biopsy referrals by providing better risk stratification could reduce health care costs and improve patient outcome.

“In the retrospective cohort study, Tasneem Lokhandwala, PhD, MS, a data analyst at Xcenda, and colleagues reviewed data collected from the 5% Medicare random national sample from 2009 to 2011…

“ ‘This study provides a baseline of current costs for the lung cancer diagnostic workup prior to the introduction of major lung cancer screening programs. Biopsy costs comprise a significant proportion of the overall cost of diagnosing lung cancer,’ Lokhandwala said in a press release. ‘These results suggest that since NCCN guidelines are not being followed, there is a need to develop more precise risk stratification tools to better identify patients who require lung biopsies. Reducing the number of patients who are referred for lung biopsies has the potential to decrease Medicare costs and ultimately improve patient outcomes.’ ”


70-Gene Signature Not Cost-Effective in Breast Cancer

The gist: Doctors sometimes use molecular tests to help make treatment decisions. These tests give information about the genetics of a patient’s tumor. Different companies make different kinds of molecular tests for patients with node-negative breast cancer (NNBC). These tests help with decision-making for adjuvant chemotherapy—chemotherapy after tumor-removal surgery to keep the cancer from returning. Recently, scientists found that one of these tests was not cost-effective when compared to other options.

“For patients with node-negative breast cancer (NNBC), the 70-gene signature is unlikely to be cost-effective for guiding adjuvant chemotherapy decision making, according to a study published online Oct. 6 in the Journal of Clinical Oncology.

“Julia Bonastre, Ph.D., from Gustave Roussy in Villejuif, France, and colleagues conducted an economic analysis of the 70-gene signature used to guide adjuvant chemotherapy decision making in patients with NNBC. The 70-gene signature was compared with Adjuvant! Online and chemotherapy in all patients as a basis for the decision to administer adjuvant chemotherapy. Costs, life-years (LYs), and quality-adjusted life-years (QALYs) were compared over a 10-year period.

“The researchers observed similar mean differences in LYs and QALYs for the three strategies. Higher cost was seen in association with the 70-gene strategy, with a mean difference of €2,037 and €657 compared with Adjuvant! Online and systematic chemotherapy, respectively. The probability of being the most cost-effective strategy was 92 percent for Adjuvant! Online, 6 percent for systematic chemotherapy, and 2 percent for the 70-gene signature, for a €50,000 per QALY willingness-to-pay threshold.

” ‘Optimizing adjuvant chemotherapy decision making based on the 70-gene signature is unlikely to be cost-effective in patients with NNBC,’ the authors write.


Lung Cancer Screening Found Cost-Effective for Medicare

“Low-dose computed tomography (LDCT) is a low-cost and cost-effective strategy for screening Medicare beneficiaries for lung cancer, according to a study published in the August issue of American Health & Drug Benefits.

“Bruce S. Pyenson, from Milliman Inc. in New York City, and colleagues estimated the cost and cost-effectiveness (cost per life-year saved) of LDCT lung cancer screening in the Medicare population at high risk for lung cancer. Medicare & Medicaid Services (CMS) beneficiary files (2012) were used to establish Medicare costs, enrollment, and demographics. CMS and U.S. Census Bureau projections were used for forecasts to 2014.

“The researchers found that approximately 4.9 million high-risk Medicare beneficiaries would meet criteria for lung cancer screening in 2014. Without screening, Medicare patients newly diagnosed with lung cancer have an average life expectancy of approximately three years. The average annual cost of LDCT lung cancer screening is estimated to be $241 per Medicare person screened. For Medicare beneficiaries aged 55 to 80 years with a history of ≥30 pack-years of smoking and who had smoked within 15 years, assuming a 50 percent screening rate, LDCT screening for lung cancer is low cost, at approximately $1 per member per month. This screening demonstrates highly cost-effectiveness, at <$19,000 per life-year saved.

” ‘If all eligible Medicare beneficiaries had been screened and treated consistently from age 55 years, approximately 358,134 additional individuals with current or past lung cancer would be alive in 2014,’ the authors write. ‘LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring.’ “


Disappointment as Breast Cancer Drug Not Approved on NHS

“The breast cancer drug trastuzumab emtansine (also known as Kadcyla) will not be made routinely available on the NHS following a failure to reach an agreement on price between the National Institute for Health and Care Excellence (NICE) and the drug’s manufacturer, Roche.

“NICE criticised the pharmaceutical company over a failure to make the drug more affordable, stating that the high price of Kadcyla makes it ‘impossible’ to recommend for widespread use in the NHS.

“The drug is licensed to treat breast cancer patients with a form of the disease known as HER2-positive breast cancer, after it has spread to other parts of the body.”