Courtney Williams, MPH @cphilwil of @ONealCancerUAB explains findings in a new study that results in lower costs and how this affects treatment and clinicians today.
Research from the UAB's O'Neal Comprehensive Cancer Center finds that patients treated outside the recommendations of the NCCN Guidelines had significantly greater direct costs.
A new study by the O'Neal Comprehensive Cancer Center at the University of Alabama in Birmingham (UAB), published in the October 2019 issue of JNCCN— Journal of the National Comprehensive Cancer Network, finds that direct costs for patients with metastatic breast cancer (MBC) increase dramatically when their treatment differs from the NCCN Clinical Practice Guidelines for Oncology (NCCN) recommendations. Previous studies have found that disagreeable care leads to higher overall health care costs, but this is the first study to look specifically at the cost burden for patients.
“We thought that it was important to explore potential differences in out-of-pocket costs, since financial toxicity is a growing issue among patients with metastatic breast cancer,” explained Courtney P. Williams, MPH, Division of Hematology and Oncology, O’Neal Comprehensive Cancer Center at UAB. “We found about one in five women received an anticancer treatment that wasn’t listed within the NCCN Guidelines. Those women were responsible for higher out-of-pocket costs—including deductibles, coinsurance, and copayments—in the year following their metastatic breast cancer diagnosis than those receiving an anticancer treatment listed within the guidelines. This finding is especially important for older patients, which made up about 75 percent of our sample, since financial and psychological distress could be worse for patients living on a fixed income.”
The retrospective study used the SEER-Medicare registry to look at the cost of patients of 3,709 women diagnosed with MBC from 2007 to 2013 who survived at least one year after diagnosis. Diagnosis plans have been linked to the version of the Breast Cancer NCCN Guidelines ® available at the exact date of diagnosis. Due to NCCN's regular guideline revisions, the concept of guideline-concordant treatment varied depending on the date.
The average post-diagnosis patient cost for the year was $5,171 for treatment that fit the current NCCN recommendations, compared to $7,421 for care that deviated from them. Overtreatment and undertreatment, as described in the guidelines, eventually resulted in higher costs for patients.