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Does Increased Spending on Breast Cancer Treatments Result in Improved Outcomes?

Yale study correlates higher costs with better results

Despite concerns about the increasing costs of treating illnesses such as breast cancer, higher treatment costs appear to be linked to better survival rates, according to a study by researchers at the Yale School of Medicine. The results were published in the April issue of Health Affairs.

“Our findings indicate that in some instances, newer and costlier approaches may be leading to improved outcomes in breast cancer patients,” said senior author Dr. Cary P. Gross. “Now we need to tackle the harder questions about what we can afford to pay, and find out which treatments are effective for each patient.”

Gross and his colleagues analyzed the Medicare billing records of 9,708 women in the U.S. between the ages of 67 and 94, who were diagnosed with stage II or stage III breast cancer. The researchers assessed trends in treatment costs and survival rates in two different eras: 1994–1996 and 2004–2006.

They found that over the course of a decade, Medicare costs for caring for women with stage III breast cancer increased from $18,100 to approximately $32,600, while the 5-year survival rate improved from 38.5% to 51.9%. Although the costs of caring for women with stage II breast cancer also increased substantially by more than 40% (from $12,300 to $17,400), the improvement in 5-year survival was more modest (67.8% to 72.5%).

“The cost increase was largely attributable to a substantial increase in the cost of chemotherapy and radiation therapy,” Gross said. “Regardless of the mechanism, the pattern is clear: higher costs of breast cancer care have been accompanied by improvements in survival.”

The authors noted, however, that the price society is willing to pay for an additional year of life remains controversial in the U.S.

First author Dr. Aaron Feinstein, currently a resident in head-and-neck surgery at the University of California, Los Angeles, said: “We view our findings as a glass half-full: survival is improving, although costs are rising substantially. We need research that can help us not only to develop new treatments, but to learn how to contain costs while we are advancing patient care.”

Sources: Yale University; April 6, 2015; and Health Affairs; April 2015.


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