“A cost-effectiveness analysis found that 9 weeks of trastuzumab therapy is better than the more standard 12 months in patients with HER2-positive breast cancer, without loss of clinical efficacy. The analysis is limited, though, by the need to combine various trials rather than any head-to-head comparisons.
“Trastuzumab has been shown to significantly improve survival in women with HER2-positive disease. ‘The budget impact of trastuzumab is high, mostly due to the drug’s high cost, and the most serious adverse effect observed is cardiac dysfunction,’ wrote study authors led by Caroline Clarke, PhD, of University College London in the United Kingdom. Though 12 months is considered the standard duration of therapy, some studies have also found similar results with only 9 or 10 weeks of trastuzumab.”
“You already know you pay too much for prescription medication. But a new study by Memorial Sloan Kettering Cancer Center reveals one simple factor that may be contributing to high costs: Waste.
“According to the new study, published Tuesday inBMJ, as much as $3 billion worth of cancer drugs is thrown away every year, unused. The reason why is drug manufacturers package single dose vials that contain more medicine than needed so that leftover medication is simply thrown away. As the authors, which includes Peter Bach, director of MSK’s Center for Health Policy and Outcomes, note:
” ‘These drugs must be either administered or discarded once open, and because patients’ body sizes are unlikely to match the amount of drug included in the vial, there is nearly always some left over. The leftover drug still has to be paid for, even when discarded, making it possible for drug companies to artificially increase the amount of drug they sell per treated patient by increasing the amount in each single dose vial relative to the typically required dose.’ “
“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.”
“Cancer is not just a physically devastating diagnosis, it can be a very expensive one. Cancer patients are more than 2 and half times more likely to go bankrupt than people without cancer.
“And the Fred Hutchinson Cancer Research Center says young cancer patients have 2 to 5 times high bankruptcy rates than those 65 and older. Those numbers are why more and more patients and families facing cancer are turning to crowdfunding to help pay their bills. The internet is making it possible for these people to tap into the kindness of strangers and friends to help them in truly desperate times.
“At the start of May, 32-year-old Meghan Morgan was occupied with all the concerns of a single mom. Juggling the dog walking business she owns, Portland Pups, an unreliable truck and raising 13 month old Henry. Now at the beginning of June, she is overwhelmed. Henry is spending his third week in the hospital, diagnosed with a rare type of inoperable cancer called neuroblastoma.”
“Gale Tickner doesn’t even know how much money she owes these days — it could be $100,000, it could be $200,000. With every surgery or unexpected complication, the medical bills for her cancer treatment keep piling up.
“Tickner has health insurance, but the numerous copayments for her hospital visits, procedures and drugs over the past year and a half have made her treatment a financial burden.
“ ‘We’re just going to take it a day at a time to pay what we can, when we can,’ she said.
“The rising cost of care is a source of growing alarm — and not just for patients. It will be a subject of debate at the annual meeting of the American Society of Clinical Oncology in Chicago this weekend, where doctors are examining new ways to package cancer treatment to make it more affordable.”
“Many patients with cancer are interested in comprehensive tumor genetic profiling (CGP), and most are willing to pay out-of-pocket costs for CGP, according to a study scheduled for presentation at the annual meeting of the American Society of Clinical Oncology, to be held from May 29 to June 2 in Chicago.
“Julie Innocent, M.D., from the Fox Chase Cancer Center in Philadelphia, and colleagues recruited 88 patients of diverse cancer histology to complete a survey in order to explore patient interest and willingness to pay out of pocket for CGP. The researchers specifically examined interest in CGP only if covered by insurance versus interest conditional on paying an out-of-pocket cost.”
“Though molecularly targeted drugs are not yet available for most cancer patients, they account for the majority of the 45 new cancer drugs launched since 2010, a report by IMS Health found.
“Personalized cancer therapy is no longer just an exciting prospect, and better survival rates — as well as escalating spending — are proving it.
“ ‘It’s here. It’s definitely here,’ said Pasi Janne, an oncologist at the Dana-Farber Cancer Institute in Boston. ‘Today, it’s the most effective way to treat patients: Figure out the genetic fingerprint of an individual’s cancer and tailor the therapies to it.’ ”
“This year, President Obama announced an initiative focused on ‘precision medicine.’
“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.’ ”
“In terms of duration of treatment and cost, patients with early stage breast cancer may benefit from accelerated partial breast irradiation (APBI) with proton therapy versus whole breast irradiation (WBI), according to new research from The University of Texas MD Anderson Proton Therapy Center.
“In a cost analysis study based on typical patient characteristics, researchers used Medicare reimbursement codes to analyze allowable charges for eight different types of partial and whole breast irradiation therapies and treatment schedules available to early stage breast cancer patients. Taken together, these represent roughly 98% of the treatment options available to these patients. The cost of proton therapy when used for APBI, introduced to decrease overall treatment time and toxicity, was estimated at $13,833. Comparatively, WBI using IMRT (x-ray) therapy resulted in the highest Medicare charges at $19,599. The average charges across the eight treatment regimens were $12,784; thus, proton costs were similar to that of other types of radiation.
“The findings were presented at the inaugural North America meeting of the Particle Therapy Co-Operative Group (PTCOG) held at MD Anderson Proton Therapy Center. A manuscript detailing the study findings is underway.”