Treatment-Related Toxicities Add Substantially To Cost Burden Of Treating Cancer Patients

STOCKHOLM, SWEDEN – Costs of cancer treatments will come under increasing scrutiny, and some hard decisions will have to be made to contain costs. In addition to outlays for drugs and hospitalization, treatment-induced complications have the potential to double the monthly tab, according to a study presented at the 2011 European Multidisciplinary Cancer Congress (ESMO/ECCO/ESTRO).

Treating metastatic breast cancer can run from $3000 to $8000 per month for each patient, and the additional cost of treatment-related toxicities with commonly used chemotherapy can add another $3000 to $4000 to that total, said Melissa Brammer, MD, Medical Director at Genentech, Inc., South San Fransciso, CA. Dr. Brammer and co-authors based these costs on claims from a U.S. database.

The study was based on 1551 patients with metastatic breast cancer treated with either chemotherapy and/or anti-HER2 therapy from 2004 to 2009. Patients were entered in the PharMetrics Integrated Database. There were 3157 episodes of treatment for treatment-related complications, each lasting an average of 131 days; 37% (1157) of episodes were HER2-based. At baseline, many of the patients had multiple comorbidities, including diabetes, arthritis, and hypertension.

Costs of drug treatment were calculated for the most commonly used agents: trastuzumab and lapatinib for HER2-positive breast cancer and docetaxel, paclitaxel, gemcitabine, vinorelbine, and doxorubicin.

The most common chemotherapy-induced complications were anemia (51% of episodes), bilirubin elevations (26% of episodes), and infection (19% of episodes). A similar pattern was found for anti-HER2 therapies: anemia, 51%; bilirubin elevation, 29%, and infections, 19%. Gemcitabine was associated with the highest rate of anemia, and capecitabine with the lowest rate, she said.

Anemia, dehydration, dyspnea, and neutropenia were the most expensive chemotherapy-related complications. The monthly costs of treatment for chemotherapy-related complications were: anemia, $3200; dehydration $3830; dyspnea, $4217; and neutropenia, $3453. Similar costs were observed with these complications in patients treated with anti-HER2 therapies.

Drug expenses were the driver for expenses associated with anemia and neutropenia, while the costs of treating dyspnea and dehydration were driven primarily by hospitalization expenses..

“The treatment-related costs presented here do not capture out-of-claims costs, such as alopecia and fatigue.  Incremental costs of treating adverse events should be considered in evaluating new therapies. There is a need for treatments that are effective, but do not incur significant toxicities,” Dr. Brammer stated.

by Phoebe Starr

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