Hutch News Stories

Ramsey: Why pay more to treat lung cancer?

SWOG study points to a regimen nearly $9,000 cheaper per patient

The most widely used chemotherapy regimen for advanced, non-small-cell lung cancer in the United States is substantially more expensive than another, equally effective treatment, according to a study conducted by members of the Hutch's Southwest Oncology Group.

A clinical trial to compare two chemotherapy regimens found that carboplatin plus paclitaxel cost an average of nearly $9,000 more per patient than treatment with cisplatin plus vinorelbine. No statistically significant differences in survival rates and quality of life emerged between the two patient groups.

Dr. Scott Ramsey, lead author and an investigator in the Public Health Sciences Division, said these findings could influence insurers, who might use the information to set guidelines as to which drugs would be covered by insurance policies.

"What's interesting from a bigger perspective," he said, "is that we're spending $1 billion a year on a drug therapy that's no more effective than one that's significantly cheaper."

The economic analysis appeared in the Feb. 20 issue of the Journal of the National Cancer Institute. Drs. Carol Moinpour, Laura Lovato and John Crowley, also of PHS, were co-authors on the study.

Top cause of cancer-related death

Nearly 170,000 Americans were diagnosed last year with lung cancer, the top cause of cancer-related death in this country. Non-small-cell lung cancers are the most common forms of the disease.

Lung cancer is estimated to cost almost $5 billion in direct medical costs annually. For this reason, Ramsey said, changes in lung-cancer treatment could have a big impact on the national health economy. The study was the first large-scale economic analysis that SWOG has conducted.

The study involved 408 patients with advanced-stage lung cancer who had not undergone prior chemotherapy treatment.

An analysis of the two therapies found that total health care costs associated with cisplatin plus vinorelbine averaged $40,292 per patient, while the costs associated with treatment with carboplatin plus paclitaxel averaged $48,940.

The calculations include many costs associated with cancer care.

Ramsey and colleagues did not see differences in costs of blood products, supportive care medications, non-protocol-related inpatient or outpatient care or nonprotocol chemotherapy.

But chemotherapy drugs and medical procedures were substantially more expensive in the paclitaxel arm; carboplatin plus paclitaxel alone was nearly $12,000 more than the cost of cisplatin plus vinorelbine.

Chemotherapy-delivery costs were higher in the vinorelbine arm, but the difference was not enough to offset the higher cost of carboplatin and paclitaxel.

Ramsey said three factors contributed to the study's uniqueness.

"First, we had joint funding from two drug companies with competing products, so this avoided any conflict-of-interest issues," he said. "Also, the trial was a large SWOG study that involved multiple institutions. Finally, we developed a system to track all relevant medical costs for each patient for nearly two years from the start of the study. For the great majority, this was the rest of their lives. Most of these patients were terminally ill."

Other large studies unlikely

Although the study results could have a big impact on health care costs, Ramsey said the high costs and resource demands required to conduct such large-scale economic analyses make it unlikely that other such studies will become common practice.

"SWOG and other oncology groups need to be selective when deciding to piggyback an economic analysis alongside a major multi-center trial."

The study was funded in part by Glaxo Wellcome Inc., which makes vinorelbine (Navelbine), and by Bristol-Myers Squibb Inc., which makes carboplatin (Paraplatin), paclitaxel (Taxol), and cisplatin (Platinol).

Added support was provided by SWOG and the NCI. SWOG is a national consortium of institutions and investigators who aim to improve the survival of cancer patients through clinical research. The group's statistical center is located in PHS.

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