HACKENSACK, NJ--The use of high-dose chemotherapy followed by
bone marrow or stem cell transplantation (BMT) for metastatic
breast cancer continues to be controversial, partially because
of concerns that it is not cost effective, Christopher E. Desch,
MD, said at a conference sponsored by the Northern New Jersey
Cancer Center, Hackensack Medical Center.
In the absence of phase III trials, cost-effectiveness analyses
have to be done with limited information, said Dr. Desch, associate
professor of medicine and health administration, and director,
Cancer Outreach and Control, Massey Cancer Center, Virginia Commonwealth
University, Richmond. Dr. Desch uses data from phase II trials,
incorporating the results of standard chemotherapy, morbidity,
and relapse costs into the equation.
Computer models of cost-effectiveness ratios can be created, but
critics argue that this "takes the art out of medicine,"
Dr. Desch said. He pointed out that this technology simply makes
the medical facts explicit and does not substitute for clinical
He noted that the data are likely to be limited for a long time
because both patients and their referring physicians refuse to
participate in the clinical trials that would provide the information
needed to show whether or not the treatment is beneficial.
BMT or any procedure is not cost effective when it is inappropriately
performed on patients who do not qualify medically, and insurers
tend to scrutinize every BMT case to avoid such inappropriate
In his role as consulting physician for Medical Care Management
Corp., Bethesda, Md, an or-ganization that ex- amines contested
medical cases for insurance companies for a fee, and pro bono
for patients, Dr. Desch reviewed about 40 BMT cases last year.
"Of the first 36 cases I reviewed, 10 had resistant disease,
five were chemosensitive, and I could not definitely determine
the status of the others," he said.