ALEXANDRIA, VaTreating a patient in a clinical trialnearly
always a cancer patients best treatment optionis no more
costly and far more effective than giving supposedly less expensive
established care, reported William P.Peters, MD, PhD,
president, director, and chief executive officer of the Barbara Ann
Karmanos Cancer Institute, Detroit. Dr. Peters discussed a series of
cost and outcome studies that reached this conclusion at the Annual
Meeting of the Association of Community Cancer Centers.
In a study of outcomes and costs in non-small-cell lung cancer
patients treated on protocol who were matched with similar
nonprotocol patients from SEER, Dr. Peters reported that the protocol
patients cost less for the first 6 months and had a median survival
almost twice as long as the off-protocol patients. The cost of
protocol-treated patients became higher at 9 and 11 months because,
compared with the off-protocol group, more protocol patients were
alive and required treatment.
In a computerized simulation of 1,000 clinical trials, he continued,
the average cost of a progression-free month was more than $1,000
less for protocol patients than for nonprotocol patients.
Breast Cancer Transplant Protocols
Similar studies of patients with metastatic breast cancer produced
similarly favorable cost and outcome results, with protocol and
nonprotocol patients costing nearly the same although the protocol
patients required fewer inpatient stays.
Dr. Peters used actual 5-year outcome data from US and South African
studies to estimate the cost of conventional treatment and high-dose
chemotherapy with bone marrow transplant for metastatic breast
cancer. Based on these data, he again performed computerized
simulations of 1,000 clinical trials of 100-patient cohorts.
The data showed that, in both countries, high-dose therapy/transplant
was more cost-effective than conventional dose therapy in terms of
cost per disease-free woman-year. However, conventional dose therapy
in the United States was less costly and more effective than similar
conventional dose treatment in South Africa. Dr. Peters emphasized
that in each case, treatment with high-dose therapy was more
cost-effective than treatment with conventional dose therapy.
Studies of outcomes and costs of treating advanced breast cancer
patients in trials of high-dose chemotherapy followed by bone marrow
transplant show that mortality from the procedure has fallen from 28%
to 2% between 1980 and 1998 and that inpatient stays have been the
biggest cost driver for this mode of treatment, Dr. Peters said.
Initially done exclusively on an inpatient basis with stays
averaging 37 days, transplant at the Karmanos Institute is now almost
entirely an outpatient procedure with 5 days the typical stay,
The newer approach to the procedure produces much greater
satisfaction; reduced infection rates; greater efficiency, with the
transplant unit able to handle three times as many patients; and
major reduction in cost, from an average of $150,000 to $65,000. By
freeing up resources, the new approach also provides the opportunity
to study other diseases in addition to breast cancer.
In answer to a question from the floor, Dr. Peters said that he did
not know the total out-of-pocket cost to the patient of co-pays, for
a family member to be available to care for the patient, and for
other requirements of outpatient transplant. He observed, however,
that even when transplant is done on an inpatient basis, someone
nearly always stays with the patient whether needed or not.
The added responsibility of actually caring for the patient in
a hotel apartment may add to the caregivers quality of
life, Dr. Peters said, as opposed to sitting around,
feeling unneeded and unhelpful, in a hospital unit. Some family
members also manage to carry on some business using computers in the
apartments. Session chair David H. Regan, MD, of Northwest
Cancer Specialists, Portland, Oregon, added that the ability of
womenespecially young mothersto gain more years of life
with their families is priceless.