With breast cancer treatment, you do get what you pay for

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Despite concerns about the increasing costs of treating illnesses such as breast cancer, higher treatment costs are linked to better survival rates, according to a study published in Health Affairs (2015; doi:10.1377/hlthaff.2014.1119).

"Our findings indicate that in some instances, newer and costlier approaches may be leading to improved outcomes in breast cancer patients," said senior author Cary P. Gross, MD, professor of internal medicine and director of the Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center at Yale School of Medicine and Yale Cancer Center in New Haven, Connecticut.

"Now we need to tackle the harder questions about what we can afford to pay, and find out which treatments are effective for each patient," said Gross.

Gross and his colleagues analyzed Medicare billing records of 9,708 women ages 67 to 94 years from across the United States, who received diagnoses of Stage II or Stage III breast cancer. The research team assessed trends in treatment costs and survival rates in two different eras: 1994-1996 versus 2004-2006.

The researchers found that over the course of a decade, Medicare costs for caring for women with Stage III breast cancer increased from $18,100 to about $32,600, while the 5-year survival rate improved from 38.5% to 51.9%. Although the costs of caring for women with stage II breast cancer also increased substantially by more than 40% (from $12,300 to $17,400), the improvement in 5-year survival was more modest (67.8% to 72.5%).

"The cost increase was largely attributable to a substantial increase in the cost of chemotherapy and radiation therapy," said Gross, who is a member of Yale Cancer Center. "Regardless of the mechanism, the pattern is clear: Higher costs of breast cancer care have been accompanied by improvements in survival."

"We view our findings as a glass half-full: survival is improving, although costs are rising substantially. We need research that can help us not only to develop new treatments, but to learn how to contain costs while we are advancing patient care," said first author Aaron Feinstein, MD, currently a resident in head and neck surgery at University of California Los Angeles.

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