Many new developments in the treatment of cancer allow targeting cancerous cells with new agents that are frequently taken orally. Despite the growth of oral oncology therapies, many antiquated health insurance plans place a larger cost burden on patients taking oral treatments than those receiving the IV treatments. There are many examples of how oral treatments are more cost effective for insurers than are IV treatments:
- In many cases, oral chemotherapy can be more cost effective than IV chemotherapy. For metastatic breast cancer patients, the annual cost of oral chemotherapy is $35,842 compared to $43,353 for IV chemotherapy.1
- The number of visits for initial care follow-ups and potential complications is substantially fewer. For colon cancer patients taking Xeloda, the average number of visits for care is 8 compared to 30 for those patients receiving the IV alternative.2
- 10% of the cost for IV chemotherapy drugs cost comes from administrative expenses including the nurse and doctor’s time.1
- A presentation at the 2007 American Society of Clinical Oncology (ASCO) outlined how IV chemotherapy administration procedures and other visit-related services accounted for 42% of total costs in patients with all forms of lung cancer.3
- Requiring parity in coverage for oral chemotherapy would not necessarily drive up premiums. One study found that the cost to expand coverage to include oral chemotherapy for most benefit plans is under $0.50 per member per month (a mere 0.17% increase).1
- With IV chemotherapy, the financial burden for patients doesn’t stop with direct medical costs.
- Patients and caregivers lose work time to go to chemotherapy treatment. The National Institutes of Health estimated lost productivity due to premature cancer deaths in the United States in 2005 at $134.8 billion (estimating about 600,000 cancer deaths that year).4
- A study by Prime Therapeutics found that one in six cancer patients with high out of pocket (OOP) costs abandon their medication. The study also found that patients with an OOP greater than $200 were at least three times more likely to not fill their prescription than those with OOP costs of $100 or less.5
- The study suggests higher OOP costs for these oncology medications negatively impact patient health as well as long-term health care costs.
1Journal of Medical Economics. 2009 Volume 12 No 3. Cost of oral capecitabine compared to intravenous taxane-based chemotherapy in first line metastatic breast cancer.
2Dentalplans.com “Xeloda should replace burdensome Intravenous Chemotherapy.” 5/19/2005.
3 Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20 Supplement), 2007:
4“Cancer Trends Progress Report – 2009/2010 Update,” National Cancer Institute, NIH, DHHS, Bethesda, MD, April 2010,
http://progressreport.cancer.gov, accessed March 4, 2011.
5Prime Therapeutics “New Study Finds One in Six Cancer Patients with High Out-of-Pocket Costs not Filling