Abstract
PurposeThe high expense of newer, more effective adjuvant endocrine therapy agents (aromatase inhibitors [AIs]) for postmenopausal breast cancer contributes to socioeconomic disparities in breast cancer outcomes. This study compares endocrine therapy costs for breast cancer patients during the first five years of Medicare Part D implementation, and when generic alternatives became available.MethodsThe out of pocket patient costs for AIs and tamoxifen under Medicare Part D drug plans were determined for 2006–2011 from the CMS Website for the 50 US states and District of Columbia.ResultsBetween 2006 and 2010, the mean annual patient drug cost under Medicare Part D in the median state rose 19% for tamoxifen, 113% for anastrozole, 89% for exemestane, and 129% for letrozole, resulting in median annual out of pocket costs in 2010 of $701, $3050, $2804, and $3664 respectively. However, the 2011 availability of generic AI preparations led to median annual costs in 2011 of $804, $872, $1837, and $2217 respectively. Not included in the reported patient costs, the mean monthly drug premiums in the median state increased 58% in 2011 compared to 2007.ConclusionsThe more effective AI agents became considerably more expensive during the first several years of the Medicare Part D program. Cost decreased with the introduction of generic agents, an intervention that was independent of the Part D program. It is unlikely that the Part D program ameliorated existing socioeconomic disparities in survival among breast cancer patients, but the availability of generic agents may do so.
Highlights
Adjuvant oral endocrine therapy for breast cancer represents one of the most important advances in treatment in the past several decades
The efficacy of tamoxifen for the 75% of postmenopausal breast cancer patients with hormone receptor positive disease was initially demonstrated by the mid-1980’s, and dozens of trials have shown that such women randomized to 5 years of tamoxifen therapy have a 47% reduction in breast cancer recurrence and 26% reduction in mortality at 10 years compared to placebo
We focus on contrasting costs faced by breast cancer patients in 2006 or 2007 to 2010 and 2011
Summary
Adjuvant oral endocrine therapy for breast cancer represents one of the most important advances in treatment in the past several decades. The efficacy of tamoxifen for the 75% of postmenopausal breast cancer patients with hormone receptor positive disease was initially demonstrated by the mid-1980’s, and dozens of trials have shown that such women randomized to 5 years of tamoxifen therapy have a 47% reduction in breast cancer recurrence and 26% reduction in mortality at 10 years compared to placebo Trials have demonstrated that aromatase inhibitor (AI) agents further reduce breast cancer recurrence rates by 30-50% compared to tamoxifen alone among postmenopausal women with hormone receptor positive disease (Dowsett et al 2010). While the AI agents are more effective than tamoxifen in preventing breast cancer recurrence, these drugs have historically been substantially more costly. This cost differential has led to marked socioeconomic disparities in their use. The use of AI agents (compared to tamoxifen) is more likely among breast cancer survivors who are wealthier, who have pharmaceutical insurance
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