SAN FRANCISCO – Despite the shorter course of care, dose-dense adjuvant chemotherapy for breast cancer may be considerably more costly than standard-dose chemotherapy, authors of a small study caution.
Neil Osterweil/Frontline Medical News
Ms. Helen O'Donovan
Among patients treated with four cycles of doxorubicin and cyclophosphamide (the AC regimen), the total cost for those treated with one cycle every 2 weeks (dose-dense schedule) was 77% higher than for patients treated once every 3 weeks, reported Helen O’Donovan, a medical student from Bon Secours Hospital and University College Cork, Ireland, and her associates.
The difference in cost was largely accounted for by the necessity for neutropenia prophylaxis with granulocytic colony stimulating factor (GCSF) among patients who received the dose-dense schedule, Ms. O’Donovan said in an interview at the 2015 ASCO Breast Cancer Symposium.
The mean cost of four doses of GCSF at her center was € 4,176 ($4,703). In the United States, a single syringe (one dose) of the long-acting GCSF pegfilgrastim (Neulasta) costs approximately $5,000 at retail pharmacies.
“We wanted to see whether GCSF in the long run might be cheaper if it could reduce admissions. It turns out that it wasn’t,” said Ms. O’Donovan.
To determine this, the investigators conducted a retrospective study comparing costs for patients treated with dose-dense chemotherapy with those treated once every 3 weeks for the same number of cycles. Because the hospital’s standard of care for several years has been the dose-dense regimen, the researchers were able to identify only 13 patients who had received the 3-week regimen. They matched these patients by age and year of diagnosis to 13 controls treated with dose-dense therapy.
All patients had early-stage breast cancer with no evidence of metastases and all were treated with AC-based chemotherapy with or without a taxane.
In all, six patients in the dose-dense group and five in the 3-week group required hospitalization for complications during chemotherapy. The mean duration of hospitalization was similar, at 4.7 and 4.6 days, respectively.
All patients in the dose-dense group received GCSF, compared with seven patients in the 3-week group. As noted, the mean costs for GCSF among patients with dose-dense chemotherapy were € 4,176 ($4,703), compared with € 1,900 ($2,139) for patients treated in the longer protocol (P = .0005).
Although the mean costs of hospitalization were not significantly different between the groups, adding in the cost of GCSF boosted the total costs to €6,163 ($6,937) vs. €3,486 ($3,923), and this difference was significant (P = .048).
Despite the GCSF prophylaxis and 100% compliance, febrile neutropenia was the most common reason for hospitalization in each group, with two patients in the dose-dense requiring hospitalization for 3 and 9 days, and three patients in the 3-week group needing admission, one for 4 days, and two for 8 days.
The authors acknowledged that the sample size was small, and that there may have been selection bias in the assignment of patients to the 3-week group.