Cost analysis of second-line therapies for platinum-refractory ovarian cancer: Reimbursement dilemmas for medicare patients

Currently used options for salvage therapy for epithelial ovarian cancer in clude intravenously administered paclitaxel or topotecan and orally adminis tered altretamine or etoposide. The response rates for these agents are sim ilar (14-26%), whereas the type and incidence of adverse events differ. Und er current legislation, Medicare will reimburse intravenous outpatient chem otherapy regimens only or oral regimens with a marketed intravenous formula tion, despite that 89% of cancer patients prefer oral therapies. To compare the out-of-pocket costs and costs to the Medicare system, a cost minimizat ion analysis of treatment with these agents was conducted using published p hase II and phase III data. The total cost of treatment was $15, 767 for pa clitaxel, $18, 635 for topotecan, $477 for altretamine, and $5016 for etopo side. The out-of-pocket costs to the patient were $83, $37 $4477 and $6, re spectively. Although a physician's first consideration in choosing a therap y is efficacy and toxicity, current Medicare reimbursement policies restric t patient options for cancer care. Because Medicare adopts managed care and health maintenance organizations into the management of patient care, cost effectiveness will likely become an important consideration in the treatme nt of cancer.