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(Drug information on epirubicin), 50 mg/m²; cyclophosphamide(Drug information on cyclophosphamide), 500 mg/m²; six courses with one course every 3 weeks); hormonal therapy (3 years of tamoxifen(Drug information on 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 for patients.