More on Cancer Cost: Toxicities

Last week’s post here about the cost of cancer—based on a 12-month investigation and subsequent study in The Lancet Oncology that has been making media waves—seemed to strike a chord. This week comes more cost news from the 2011 European Multidisciplinary Cancer Congress, this time focused on side effects.

One of the vital perceptions in The Lancet Oncology‘s report was that the cost of cancer care tends to be lopsided; that is, only certain people are privy to the actual cost of a drug or a procedure. That seems significant, because not knowing the true cost keeps us handicapped in terms of making decisions about our health or having a well-informed thought about healthcare.

I remember my obstetrician having no clue that the prescription vitamins he was recommending were going to cost me $50 per month. Aside from the fact that they tasted strangely good (and that was but a fleeting pleasure, from the sugary gel cap as it slid down my throat), there was nothing special about them, nothing that I couldn’t get from an over-the-counter, much less expensive bottle. I sat on the other side of his big desk and asked him if there was any reason that I had to take these pricey pills. “Oh, I don’t know about prices,” he said. “I suppose you could just take a regular prenatal vitamin.” It was after that appointment that I switched to a midwife.

That tangent hardly touches the severity and importance of cancer treatment, but I think it illustrates, even in a roundabout way, the uneven ground on which cost puts healthcare providers and consumers. How much steeper is that slope when it’s a doctor unaware of a co-pay of a few hundred dollars, or a patient unaware of the $30,000 price tag to taxpayers for their treatment, or an uninsured patient about to go bankrupt from one more round of chemotherapy?

So, for the sake of simply getting the information out there, here’s the latest from the EMCC meeting. A study just reported there by Melissa Brammer, MD, Medical Director at Genentech, and co-authors based on claims from a U.S. database delivered some important numbers.

The study looked at claims from 1,551 patients with metastatic breast cancer treated between 2004 and 2009 with chemotherapy and/or anti-HER2 therapy (eg, trastuzumab or lapatinib). These patients had a total of 3,157 treatments for side effects, with the following tallies:

- Toxicity treatments lasted an average of 131 days
- The most common complication among all the patients was anemia, followed by bilirubin elevations and infection.
- The most expensive complications related to chemotherapy were anemia, dehydration, dyspnea and neutropenia. The costs per month were $3,200 for anemia, $3,830 for dehydration, $4,217 for dyspnea, and $3,453 for neutropenia.

As the authors noted, unaccounted for here are out-of-pocket costs for side effects like alopecia (hair loss).

The study found that the side effects associated with chemotherapy and anti-HER2 therapy were about the same, give or take, and also found that adding an anti-HER2 drug to the chemotherapy regimen did not affect the rates of complications.

Considering that this study was sponsored by Genentech—maker of Herceptin (trastuzumab) and co-opters of the gene.com URL—you have to wonder what was the point of this study? To show that chemotherapy is not better than a monoclonal antibody at minimizing side effects? The authors note the importance of finding treatments that not only kill cancer cells but that also have minimal side effects, and that the cost of treating adverse events needs to be considered when new treatments are being developed and brought to market. Whatever the intention is, there is value in seeing these numbers, and in remembering that the cost of a treatment does not lie with its per-dose price point alone, but with whatever ancillary expenses tag along with it.

There’s a bit more on this report here and here.

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