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 trials."