Wide Variation in cost of Treating Colon Cancer

This article in the American Journal of Managed Care only tells half the story. It reports on the costs of chemotherapy for colon cancer using conventional chemotherapeutic agents. As reported common regimens costs are:

Total Cost of 6 Cycles of Commonly Prescribed Treatment Regimens

Chemotherapy Regimen Total Cost of Treatment ($)
5FU/LV (5-flurouracil plus leucovorin) 1,028
IFL/FOLFIRI (flurouracil/leucovorin/irinotecan) 38,027
FOLFOX (fluorouracil/leucovorin/oxaliplatin) 17,584
Irinotecan 25,287
CapeOx (capcitebine/irinotecan/oxaliplatin) 34,744
Oxaliplatin 11,593

Part of the wider variation in cost is the need for leukocyte stimulating factor (GCSF) and erythropoietin with the more aggressive regimens. Given the large difference in cost to the system one wonders why a historical comparison of the effectiveness of the various regimens was not included.

The study was completed in 2005 and the cost variation may be worse now:

“This variation is likely to be even bigger now that monoclonal antibodies, such as cetuximab (Erbitux) and bevacizumab (Avastin), have been accepted as standard therapies to be added onto chemotherapy regimens. The study finished at the end of 2005, and so did not assess the impact of these new products, Dr. Lyman explained. It focused on chemotherapy regimens and found enormous variations in cost. “As bad as it looked then,” Dr. Lyman commented in an interview, “I would guess it is even worse now.”

Cetuximab and bevacizumab may increase costs by as much as $10,000/month and only improve the outcome by a modest amount.

The larger question is whether physicians and institutions should factor in cost to the treatment equation. It’s been our practice to ignore cost when considering treatment alternatives but as the expenditures for health care increase exponentially it may be time to consider another approach.

It is difficult for individual physicians to do all the work on this. In UK there is an agency, the Nation Institute for Health and Clinical Excellence (NICE), that produces studies and make recommendations to their National Health Service. A similar non-biased source of cost/effectness evaluation in our system should be welcomed by all practitioners. For what it’s worth the FDA is prohibited from including cost in their evaluations of new drugs.

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