Systemic therapy in breast cancer: efficacy and cost utility

Cancer treatment accounts for a large proportion of healthcare costs. Often, new treatment modalities provide benefits, but at high costs. The impression that cancer treatment is expensive is enhanced by publicity surrounding treatments like bone marrow transplantation. There is a need to evaluate costs of different treatment approaches and to address the cost utility of cancer treatment in general compared with therapies for other conditions. Breast cancer can serve as a good model for economic evaluation of cancer treatment because of the broad range of treatment options and objectives it encompasses, and also because well defined benefits can be achieved. The cost utility of contemporary adjuvant therapy strategies, specifically chemotherapy in premenopausal women and hormonal treatment in estrogen-receptor (ER) positive pre- as well as postmenopausal women, seems favourable. Cost-utility ratios {cost per quality-adjusted life-year (QALY) gained} range from $US4000 to $US10 000. However, hormonal treatment in ER-negative women may be associated with cost-per-QALY ratios of $US50 000 to $US200 000. So far there are no published cost-utility analyses of neo-adjuvant therapy or adjuvant bone marrow transplantation as the long term effects of these treatment options are undefined. Few data exist on cost utilities of systemic drug treatment in advanced breast cancer, although drugs may account for only a moderate part of the total treatment and caring costs. Bone marrow transplantation in patients with metastatic breast cancer costs about $US100 000 per QALY, which is expensive.