Prospective cost analysis from the provider's perspective: pharmaco-economic results from AGO-WSG intergroup adjuvant EC→DOC trial vs. CMF in nodal-positive breast cancer and its reimbursement.
Authors: Jacobs VR , Braun M , Harbeck N , Wagenpfeil S , Sattler D , Bernard R , Kuhn W , Nitz U , Ihbe-Heffinger A 
Published: December 2010

Abstract
Abstract #6111
Background:&#x2028; Understanding of all cost aspects of oncological therapies is precondition for analyzing cost-effectiveness in oncology. Taxane-based adjuvant chemotherapy is the current standard for nodal positive breast cancer patients but at higher costs than earlier therapies. Compared to a previous standard CMF or anthracycline containing regimens, the increase in efficacy is modest but significant. Besides to clinically relevant adverse events, the implementation of taxanes is associated with remarkable higher health resources consumption. In the study presented, a modern taxane-based sequential regimen (4x epirubicin/cyclophosphamide followed by 4x docetaxel q21; EC→DOC) was compared to cheaper and less toxic CMF in patients with primary nodal positive breast cancer. A comprehensive analysis of resource consumption and costs including reimbursement for the university outpatient setting was performed.&#x2028; Method:&#x2028; Data on chemotherapy application and resource consumption were obtained between 2/2000-5/2002 parallel to the prospective, randomized, multicenter phase III WSG-AGO Intergroup EC→DOC trial (1999-2005) comparing EC→DOC to CMF or FEC. Total costs and reimbursement were presented from the provider's (=hospital) perspective.&#x2028; Results:&#x2028; A cohort of 110 patients from 38 study centers receiving a total of 1,047 chemotherapy-cycle days was analyzed. The mean patient age was 52.4 years. Mean costs for the EC→DOC group (n=54) totaled EURO 8,459 per patient (95% CI: EURO 7,785-9,132) with costs for cytostatics being the largest burden (EURO 5,673; 67%). Staff costs for drug application and pharmacy services including transport were EURO 1,357 (16.0%), average basic hospital costs EURO 414 (4.9%) and EURO 376 (4.4%) for diagnostic effort and port or catheter insertion. Hospitals spent EURO 354 (4.2%) on supportive drugs, administration, devices and infusion bags. Rehospitalisation (n=7) due to chemotherapy toxicity accounted for EURO 313 (3.7%). In comparison CMF is significantly less expensive (-41.2%) with mean costs of only EURO 4,973 (95% CI: EURO 4,706-5,240). After flat rate reimbursement of 600 Euro / cycle day EC→DOC results in a loss of EURO 3,659 and CMF in a gain of EURO 2,227 for the hospital.&#x2028; Conclusions:&#x2028; These results show a substantial budget increase for innovative therapies like taxanes vs. older regimen which can lead to a loss for the applying institution. The flat rate reimbursement does not reflect the actual costs for the provider and is likely not necessarily cost covering for innovative therapies. This data allows adjustment of care to cost from the provider's perspective to avoid subsidizing oncological therapies and health insurance to adjust reimbursement for oncological therapies according to actual costs for providers.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6111.