Considering the high cost of cancer recurrence, the incremental cost
of adjuvant treatment appears to be reasonable, particularly if recurrences
can be avoided, maintain a group of French researchers. Dr. C. Bercez at
the Oscar Lambret Cancer Center and other investigators at the Centre de
Recherches Economiques, Sociologiques et de Gestion, in Lille, France,
evaluated the medico-economic impact of adjuvant treatment in the management
of breast cancer and presented their findings at the 19th Annual San Antonio
Breast Cancer Symposium. They examined two types of costs: charges related
to adjuvant therapy--that is, charges incurred from adjuvant treatment
and patient monitoring during the follow-up period of nonrecurrence--and
costs of a recurrence, whether local, metastatic, or both, which represent
the benefit of the adjuvant treatment.
The report concluded that the acquisition cost of endocrine treatment
is low compared with the total cost of this strategy. Hormonal therapy
is economically comparable to standard follow-up of patients with no treatment.
Chemotherapy represents the most costly of adjuvant strategies, and its
incremental cost could be increased with the use of new drugs.
Four strategies were examined: chemotherapy (FEC 50--fluorouracil, 500
mg/m²; epirubicin, 50 mg/m²; cyclophosphamide, 500 mg/m²;
six courses with one course every 3 weeks); hormonal therapy (3 years of
tamoxifen [Nolvadex] at 20 mg/d); a combination of both treatments; and
no adjuvant therapy at all.
Follow-up costs were estimated according to the patient monitoring carried
out during the period without recurrence. Costs were quantified as those
external to the hospital (transportation, physician visits, nurse care,
physiotherapy, and biologic and radiologic examinations), and hospital-related.
Hospital costs were estimated according to the type of treatment administered
and the patient monitoring necessary.
Respective total costs at 5 and 10 years were: for hormone therapy,
$8,708 and $10,946; for chemotherapy, $12,753 and $14,991; for both, $13,778
and $16,174; and for no adjuvant treatment, $7,683 and $9,921. A survey
of 146 medical records yielded the median costs of each type of recurrence,
which were $35,033 for metastatic recurrence, $57,516 for local recurrence
followed by metastases, and $23,141 for local recurrence not followed by
metastases. Considering the high cost of a recurrence, the cost of an adjuvant
treatment appears to be reasonable, especially if it can avoid some recurrences