Significantly different costs of adjuvant chemotherapy regimens in the United States.

Abstract

1131 Background: We examined the relative and absolute costs in the United States for several widely used breast cancer adjuvant chemotherapy regimens. Although clinical trials commonly report the endpoints of efficacy (in terms of relapse free survival and overall survival) and toxicity, clinical trials rarely comment on the costs of the therapy. There are several reasons for this. One is that the costs are time and site and/or country specific. It is noteworthy that the total cost ideally includes the cost for care and may not be easily captured from the clinic (additional laboratory tests, radiology, hospitalization, etc.). Nonetheless simple cost estimate based on costs in the clinic can be so strikingly different, that they would seem to worth taking into consideration and examining further. Methods: To make the estimates we used the Regimen Profiler available at https://www.onmarkservices.com. We used Medicare reimbursement cost estimates effective in January 2011. The cost estimates were based treatment of a 70 kg woman with a BSA of 1.6 m2. Results: An example of these analyses are cost estimates for the chemotherapy alone which for dose dense CA (Q2w)*4 followed by P (q2w)*4, CA (q3w)*4 followed by P (qw)*12, DAC (q3w)*6, and 4*DC (q3w)*4 were: $924, $1,024, $14,827, and $9,890 respectively. For the dose dense regimen and the DAC regimen growth factor support is recommended. If the cost of support with a long acting form of CSF is included the costs become $21,274, $4,140, $31,222, and $10,651. Conclusions: We found that estimates of the cost of adjuvant chemotherapy regimens varied widely. The inclusion of a non-generic agent, or the necessity of routine growth factor support greatly increase the cost. By far the least costly of the third generation adjuvant breast cancer regimens was CA*4 then P*12, the efficacy and safety of which was established in E1199. The DC regimen cost comparatively little but, estimates of its efficacy and safety are based on only one trial against a relatively simple regimen. We conclude the cost differentials between widely used breast cancer regimens for adjuvant therapy are so large that particularly when efficacy and safety are approximately equal, that cost should be estimated and taken into consideration.