New chemotherapy agents appear associated with improvements in survival time for patients with metastastic colorectal cancer, but at substantial cost. David H. Howard, Ph.D., and colleagues at Emory University, Atlanta, used a cancer registry database to measure trends in life expectancy and lifetime medical costs in 4,665 patients age 66 and older diagnosed with metastastic colon cancer between 1995 and 2005. Patients were classified according to whether they received one or more of the six chemotherapeutic agents approved for the treatment of metastastic colon cancer between 1996 to 2004.
Among those who received the new agents, life expectancy increased by 6.8 months and lifetime costs increased by $37,100, equating to a cost of $66,200 per year of life gained. After additional adjustments, the cost for each quality-adjusted life year (a year of life in perfect health) gained was $99,100, the authors note.
“New chemotherapeutic agents for colorectal cancer have been singled out as examples of high-cost/low-value medical care; no doubt they are the types of therapies that would receive close scrutiny if Medicare and other payers were to consider cost-effectiveness in coverage decisions,” they write. “Our estimate of the cost per quality-adjusted life year gained, $100,000, is below most estimates of the willingness to pay for a life-year. However, continuation of Medicare’s open-ended coverage policy for new chemotherapeutic agents and other expensive technologies will prove difficult to sustain as costs for the program continue to rise.”
(Arch Intern Med. 2010;170:537-542).