Estimating regimen-specific costs of chemotherapy for breast cancer: Observational cohort study

Authors

  • Sharon H. Giordano MD, MPH,

    Corresponding author
    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
    2. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Corresponding author: Sharon H. Giordano, MD, MPH, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1444, Houston, TX, 77030-4009; Fax: (713) 563-0059; sgiordan@mdanderson.org

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  • Jiangong Niu PhD,

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Mariana Chavez-MacGregor MD, MSC,

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
    2. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Hui Zhao PhD,

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Daria Zorzi MD, MS,

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Ya-Chen Tina Shih PhD,

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Benjamin D. Smith MD,

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
    2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Chan Shen PhD

    1. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • We thank Gary Deyter for his editorial assistance.

Abstract

BACKGROUND

One goal for high-quality patient care is communicating treatment costs to patients, yet cost information can be elusive. This is especially relevant for breast cancer care, for which numerous guideline-concordant adjuvant chemotherapy regimens exist. The objective of the current study was to generate cost estimates for such regimens from payers’ and patients’ perspectives in a large, insured US population.

METHODS

Adult women who had incident breast cancer diagnosed between 2008 and 2012 (from the MarketScan database), had no secondary malignancy within 1 year of diagnosis, and received chemotherapy within 3 months of diagnosis were included (n = 14,643). Total and out-of-pocket costs were calculated using all claims within 18 months of diagnosis and were normalized to 2013 US dollars. The extended estimating equations method was used to assess cost by regimen adjusting for demographic and clinical factors.

RESULTS

Among patients who did and did not receive trastuzumab, the median insurance payments were $160,590 and $82,260, respectively, and the median out-of-pocket payments were $3381 and $2724, respectively. Among patients who did not receive trastuzumab, 25% paid more than $4712, and 10% of patients paid more than $7041. For patients who did receive trastuzumab, 25% paid more than $5604, and 10% paid more than $8384. Among patients who were covered by high-deductible health plans, the median out-of-pocket cost was $5158, 25% paid at least $8128, and 10% paid ≥ $11,344.

CONCLUSIONS

The costs of breast cancer chemotherapy vary widely across regimens, and patients bear a substantial out-of-pocket burden. Cancer 2016;122:3447–3455. © 2016 American Cancer Society

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