Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer

Article Abstract:

The 1988 Clinical Alert issued by the National Cancer Institute indicated that chemotherapy had meaningful effects on the development of disease in women with node-negative breast cancer. This has been widely interpreted as suggesting that chemotherapy should be used more extensively. Since the majority of women with breast cancer whose disease has not yet spread to the lymph nodes of the armpit will achieve long-term survival without chemotherapy, it is important to examine both the costs and benefits of chemotherapy for these patients. It is clear that the use of chemotherapy for node-negative breast cancer patients would result in the needless treatment of many women. In addition, the aggregate yearly cost of this additional treatment would be roughly $338 million. The authors investigated the potential benefits of expanding the use of chemotherapy by developing a Markov model of node-negative breast cancer. (Markov models are probabilistic models; named for the Russian mathematician Markov, they are generally used in cases where a system can progress through possible states and the probability of moving into a new state is determined only by the state the system is in.) The model evaluated the cost-effectiveness of chemotherapy for 45- and 60-year-old women under varying sets of assumptions. The investigators found that for the standard assumptions, the 60-year-old woman gained about four months of quality life at a cost of $18,800 per year while the 45-year-old woman gained 5.1 months at a cost of $15,400 per year. Unfortunately, little is known about the differences between women with node-negative cancer and high risk of recurrence and those with low risk of recurrence. If it turns out that chemotherapy is not equally effective in both groups, then the chemotherapy is less effective. Furthermore, improved disease-free survival resulting from chemotherapy may not result in improved overall survival, and this, too, may affect the expectations. The authors suggest that the uncertainty is too great for many women to choose chemotherapy. However, the authors hope that it might be possible to identify a subset of high-risk patients who might gain proportionately more from chemotherapy. Unfortunately, there is not yet any evidence that this admirable goal can actually be accomplished with the knowledge at hand. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Chemotherapy, Adjuvant chemotherapy

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Efficacy and cost-effectiveness of autologous bone marrow transplantation in metastatic breast cancer: estimates using decision analysis while awaiting clinical trial results

Article Abstract:

Patients with metastatic breast cancer may benefit from autologous bone marrow transplantation (ABMT), but this treatment may be too expensive for widespread use. Patients who receive ABMT are infused with their own bone marrow to strengthen their immune system after chemotherapy. A mathematical model was used to estimate the survival time and cost of treatment for a hypothetical group of 45-year-old women with metastatic breast cancer who were treated with high dose chemotherapy followed by ABMT, or with standard chemotherapy. One year after starting treatment, 36.1% of the patients who received intensive chemotherapy followed by ABMT were in complete remission, compared to 8.2% of the patients treated with standard chemotherapy. Five years after treatment, average survival time for patients who received intensive chemotherapy followed by ABMT was 27.4 months, and average survival time for patients who received standard chemotherapy was 21.4 months. The cost of ABMT was $115,800 per year of life saved.

Health aspects, Care and treatment, Bone marrow, Bone marrow transplantation, Autografts

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Hospital Volume and Patient Outcomes in Major Cancer Surgery

Article Abstract:

Patients needing complex surgery should be referred to hospitals that perform many such procedures. A 1998 study found that hospitals that did many cancer surgeries had lower mortality rates. Patients with heart disease have been shown to benefit from treatment at hospitals that treat many such patients. These so-called high volume hospitals could substantially lower mortality rates in many patients.

Maryland, Editorial, Hospitals, Cancer patients

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