HACKENSACK, NJ--The use of high-dose chemotherapy followed by bone marrow or stem cell transplantation (BMT) for metastatic breast cancer continues to be controversial, partially because of concerns that it is not cost effective, Christopher E. Desch, MD, said at a conference sponsored by the Northern New Jersey Cancer Center, Hackensack Medical Center.
In the absence of phase III trials, cost-effectiveness analyses have to be done with limited information, said Dr. Desch, associate professor of medicine and health administration, and director, Cancer Outreach and Control, Massey Cancer Center, Virginia Commonwealth University, Richmond. Dr. Desch uses data from phase II trials, incorporating the results of standard chemotherapy, morbidity, and relapse costs into the equation.
Computer models of cost-effectiveness ratios can be created, but critics argue that this "takes the art out of medicine," Dr. Desch said. He pointed out that this technology simply makes the medical facts explicit and does not substitute for clinical judgment.
He noted that the data are likely to be limited for a long time because both patients and their referring physicians refuse to participate in the clinical trials that would provide the information needed to show whether or not the treatment is beneficial.
BMT or any procedure is not cost effective when it is inappropriately performed on patients who do not qualify medically, and insurers tend to scrutinize every BMT case to avoid such inappropriate use.
In his role as consulting physician for Medical Care Management Corp., Bethesda, Md, an or-ganization that ex- amines contested medical cases for insurance companies for a fee, and pro bono for patients, Dr. Desch reviewed about 40 BMT cases last year.
"Of the first 36 cases I reviewed, 10 had resistant disease, five were chemosensitive, and I could not definitely determine the status of the others," he said.