WASHINGTON--A General Accounting Office (GAO) report has found
that more insurers are now covering autologous bone marrow transplants
(ABMT) for patients with breast cancer even though the treatment
is expensive and the benefits are not proven.
The procedure costs from $80,000 to $150,000, compared with $15,000
to $40,000 for more conventional therapy, the report said.
[Editors' note: William P. Peters, MD, PhD, formerly of Duke University
and now chief and CEO of the Karmanos Cancer Institute, Detroit,
said at ASCO that costs for ABMT in the outpatient setting are
approximately $65,000, and that his patients have been quite successful
in obtaining coverage for such transplants. In his breast cancer
transplant study reported at ASCO, only four of 105 eligible patients
were not randomized due to insurance company refusal to pay.]
The GAO's survey of 12 major insurers found that companies are
basing their decisions to pay for transplants on preliminary clinical
research rather than waiting for completion of ongoing randomized
trials. Nonmedical factors, such as fear of litigation and adverse
public relations, also play a role, the insurers reported.
In some cases, the companies may not have a choice, since at least
seven states have mandated that insurance companies, under certain
conditions, must provide such coverage and seven others states
have similar legislation pending (see table). Moreover, the National
Association of Insurance Commissioners is considering a model
act for states that would set minimum standards of coverage.
The GAO report raises questions about the growing popularity of
ABMT, noting that "the public is not well-served by the proliferation
of an unproven treatment that is costly and possibly harmful."
Scientists at the National Cancer Institute said that the report
underscores the urgent need to complete transplant studies. "The
preliminary evidence on bone marrow transplants is based on small,
mostly nonrandomized trials that do not define the role of transplants
in the treatment of breast cancer," said Jeffrey Abrams,
MD, senior investigator at the NCI. "The GAO report clearly
supports the need for large, carefully controlled, randomized