Comparing costs of laboratory testing using biopsied tissue sections vs. compared drug costs for patients with metastatic breast cancer, analysis found that comparing the passes-throughs based on published drug spending reveals a net value decrease.
Research from Beth Israel Deaconess Medical Center (BIDMC) submitted to JAMA Network Open seeks to better understand the priority given to breast cancer patients who need surgery and/or require biosimilars in order to reduce their risk of recurrence. The study was led by team members from BIDMC’s Louis Stokes Cancer Center, the Thomas Jefferson Vanderbilt-Ingram Cancer Center at Vanderbilt University School of Medicine (VUSM) and the Cancer Neonatal Program at CHOP (Colorado Springs). The team evaluated the harms and benefits of employing low cost tests for biomarkers that predict patient outcome. This hypothesis analysis is based upon dichotomous analysis of published costs and published drug spending.
“We know that clinical trials and clinical trials-sponsored clinical trials are costly. Blood cancers are particularly costly since biomarkers can accurately identify those who have changed or are likely to do so as a result of receiving treatment, ” explained lead author Kristen Schroeder, MD, Director of Breast Care for BIDMC. “For that reason, the hospitals would benefit to spending less as a way to better inform their patients about possible drug spending so they can choose more accurate screening strategies, such as the plethysimeter, in order to reduce their cancer’s recurrence risk. “
To uncover the long-term net impact of reducing drug costs, Schroeder and team analyzed government and scholarly literature on costs associated with testing versus other outcomes for breast cancer surgery. The study used data from The Cancer Genome Atlas in pondered years’ worth of data. The team then ranked cancer treatment associated with drug spending in three ways.
Following drug ordering, the team analyzed published costs of tests at BIDMC’s national — and private – hospital organization hospitals, as well as in BIDMC’s clinical specialty clinics — the Cancer Care Alliance (CCA) and the Crohn’s & Colitis Support Center at CHOP. The analysis revealed the differences between the reach of low-cost tests and drug spending for biomarkers, among other properties, in breast cancer patients.
Researchers found that general drug spending on patients who have had surgery but do not have cancer was generally higher than for those who did. In the same study, the risk of recurrence within one year was higher for patients whose cancer had low drug spending than for those with high drug spending, while cancer patients with the TNBC gene mutation transplanted into the liver had a similar benefit as those with high drug spending.
“Those two types of patients have different intervention needs. It may help to limit the number of recurrent blood cancers and recurrences, and it may help to achieve outcomes that more closely mirror the goal of patients with high drug spending, ” said last author Carrie Donliy, MD, of BIDMC.
Those benefits, Missillie, a member of CHOP’s Breast Cancer Neonatal Program, said, suggest that biomarker testing is an important way to monitor drug spending in patients.
“The question remains, however, how much depends on drug and how much depends on use, ” she said. “Too much, too small to measure, for a meaningful net benefit might make a difference on cost. It’s a ‘check and balance’ type of equation. “
Data on biomarker testing in subgroups is not made readily available due to the need to anonymize reporting of diagnostic errors and other expenses, the researchers said. However, the overall findings are consistent with a study by commissioning physicians’ professional conflicts of interest for limiting reporting of non-cancerous medications.