ReCAP: Cost Differential of Chemotherapy for Solid Tumors

QUESTION ASKED: The objective of the present study is to determine the cost differentials between chemotherapeutic regimens (of similar or acceptable effectiveness) for common solid tumors in the metastatic and adjuvant settings. SUMMARY ANSWER: Of the 62 regimens included, the 6-month mean cost of chemotherapy was $26,989, and the median cost was $9,611. Mean cost of metastatic cancer therapy regimens was $35,315 compared with $18,107 for curative therapy. Regimens using biologics had higher mean costs than regimens not using biologics ($77,278 v $13,646). Cost differential between extremes of costs for regimens with presumed similar efficacy was Δ$90,843; $79,165 in the curative therapy arms and $90,210 in the metastatic cancer therapy arms. The highest cost differential was noted in breast cancer regimens (Δ$71,041 for metastatic v Δ$63,926 for curative). METHODS: Chemotherapy regimens—curative (adjuvant/neoadjuvant) and metastatic—and dosages outlined in National Comprehensive Cancer Network guidelines (2013) were acquired for four common cancers: bladder, breast, colon, and lung. Baseline drug and treatment costs were calculated for the average US adult male using the payment allowance for Medicare part B drugs database (2013). Costs were extrapolated for a treatment period of 6 months. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: The calculations used payer perspective for the drug and the reimbursement, which may not truly reflect the actual costs incurred by the individual or society. However, the simplicity provides the strength of inferences which are fairly robust across the sensitivity analysis. REAL-LIFE IMPLICATIONS: A significant cost differential exists between chemotherapeutic regimens for the commonest solid tumors. In the absence of existing cost-effectiveness guidelines, cost differentials can help practicing oncologists in financially sound decision making regarding choosing therapy. Incorporation of costs and incremental effectiveness in currently established guidelines may encourage socially responsible practice patterns.