BREAST COST GO UP WITH SURVIVAL

Healthcare costs have been rising faster than inflation in the United States, and cancer care is no exception.

"However, in some instances, newer and costlier approaches to care may be leading to improved outcomes," say the authors of a study published in the April issue of Health Affairs.

Adjuvant therapies that weren't available earlier on are helping to improve survival, said lead author Aaron J. Feinstein, MD, from the Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale University School of Medicine in New Haven, Connecticut.

In fact, over the course of a decade, the cost to treat a woman with stage II disease rose from $12,335 to $17,396 and the 5-year survival rate improved from 67.8% to 72.5%.

The association was similar for stage III disease. The cost nearly doubled, from $18,107 to $32,598, and the 5-year survival rate improved from 38.5% to 51.9%.

"In breast cancer and other diseases, the goal is to identify best practices" and "the treatments that will be most helpful to the patient," Dr Feinstein told Medscape Medical News.

For example, if the physician explains to the patient that a treatment is unlikely to increase survival or to be of value, it that can help lower the cost. Conversely, "if we know that something is going to be very helpful, we need to encourage them to use it," he said.

However, "in the United States, we are not at the point we see in some countries, like the United Kingdom, where there is a threshold value," he explained. "In the United States, there is no societal agreement on what life is worth monetarily."

In 2010, the cost of treating breast cancer was about $16.5 billion in the United States, which is higher than for any other malignancy. This is expected to increase to $20.5 billion by 2020.

However, few studies have looked at the association between trends in costs and survival outcomes.

Surgery Cost Declined, Other Costs Increased

To do just that, Dr Feinstein and his colleagues identified women 67 to 94 years of age who were diagnosed with stage II or III breast cancer in 1994 to 1996 or 2004 to 2006 from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database.

Of the 5037 women in the early group, 82% had stage II disease. Of the 4671 in the late group, 76% had stage II disease. The majority of women were older than 75 years.

Median cancer-related costs and survival rates were both higher in the late group than in the early group for the two disease stages and for all age strata analyzed.

Table 1. Increases in Cancer-Related Costs Over Time

Disease Stage	Median	Mean
II	41%	41%
III	80%	62%

Although the median cost of breast surgery declined between the two study periods, the median cost of other therapies increased substantially. This reflects the increased used of breast-conserving surgery over time for patients with both stages of disease, and the increase in surgeries performed in the outpatient setting, Dr Feinstein explained.

At the same time, the use of both chemotherapy and radiation therapy increased (P < .001).

The cost of surgery, including breast-conserving surgery and mastectomy, decreased from $10,552 to $3592 for women with stage II disease, and from $12,108 to $10,457 for women with stage III disease.

Conversely, the cost of nonsurgical interventions increased more than 2-fold — from $10, 993 to $22,011 for women with stage II disease and from $11,538 to $25,578 for women with stage III disease.

Table 2. Costs and Survival Rates

Variable	Early Group	Late Group	Increase	PValue
Stage II disease
Total cost	$12,335	$17,396	$5061	<.001
3-year survival	80.9%	82.8%	1.9%	.050
5-year survival	67.8%	72.5%	4.7%	.001
Stage III disease
Total cost	$18,107	$32,598	$14,491	.001
3-year survival	59.4%	68.1%	8.7%	<.001
5-year survival	38.5%	51.9%	13.4%	<.001

"Everyone working in medicine has the goal of improving the length and quality of life, and that's our continual focus for individual patients," said Dr Feinstein. "That's what we're vested in doing and most able to do."

Physicians and other healthcare professionals can play a role in reducing healthcare spending and the impact it has on society. "Its sometimes hard for individuals to see that in their own practice, being that the issue is so large, but we need to start at the individual level to make any sort of change down the road," he explained.

This study was supported by grants from the National Cancer Institute and the Doris Duke Charitable Foundation. Dr Feinstein has disclosed no relevant financial relationships. Some of his coauthors report financial relationships with industry and organizations, as detailed in the publication.

Health Aff (Millwood). 2015;34:592-600. Abstract