High Costs of Recurrence Avoided With Adjuvant Treatment, According to Medico-economic Evaluation

Considering the high cost of cancer recurrence, the incremental costof adjuvant treatment appears to be reasonable, particularly if recurrencescan be avoided, maintain a group of French researchers. Dr. C. Bercez atthe Oscar Lambret Cancer Center and other investigators at the Centre deRecherches Economiques, Sociologiques et de Gestion, in Lille, France,evaluated the medico-economic impact of adjuvant treatment in the managementof breast cancer and presented their findings at the 19th Annual San AntonioBreast Cancer Symposium. They examined two types of costs: charges relatedto adjuvant therapy--that is, charges incurred from adjuvant treatmentand patient monitoring during the follow-up period of nonrecurrence--andcosts of a recurrence, whether local, metastatic, or both, which representthe benefit of the adjuvant treatment.

The report concluded that the acquisition cost of endocrine treatmentis low compared with the total cost of this strategy. Hormonal therapyis economically comparable to standard follow-up of patients with no treatment.Chemotherapy represents the most costly of adjuvant strategies, and itsincremental cost could be increased with the use of new drugs.

Four strategies were examined: chemotherapy (FEC 50--fluorouracil, 500mg/m²; epirubicin, 50 mg/m²; cyclophosphamide, 500 mg/m²;six courses with one course every 3 weeks); hormonal therapy (3 years oftamoxifen [Nolvadex] at 20 mg/d); a combination of both treatments; andno adjuvant therapy at all.

Follow-up costs were estimated according to the patient monitoring carriedout during the period without recurrence. Costs were quantified as thoseexternal to the hospital (transportation, physician visits, nurse care,physiotherapy, and biologic and radiologic examinations), and hospital-related.Hospital costs were estimated according to the type of treatment administeredand the patient monitoring necessary.

Respective total costs at 5 and 10 years were: for hormone therapy,$8,708 and $10,946; for chemotherapy, $12,753 and $14,991; for both, $13,778and $16,174; and for no adjuvant treatment, $7,683 and $9,921. A surveyof 146 medical records yielded the median costs of each type of recurrence,which were $35,033 for metastatic recurrence, $57,516 for local recurrencefollowed by metastases, and $23,141 for local recurrence not followed bymetastases. Considering the high cost of a recurrence, the cost of an adjuvanttreatment appears to be reasonable, especially if it can avoid some recurrencesfor patients.