title: Cost Differential of Chemotherapy for Solid Tumors.
abstract: OBJECTIVE
  A significant portion of national cancer expenditure is attributed to chemotherapy.Although the National Comprehensive Cancer Network has generated recommendations for the treatment of various solid tumors, the outlined chemotherapeutic strategies lack information about the cost differential for increasing effectiveness.
  
  
  METHODS
  Chemotherapy regimens (curative [adjuvant/neoadjuvant] and metastatic therapy) and dosages outlined in the 2013 National Comprehensive Cancer Network guidelines were acquired for four common cancers: bladder, breast, colon, and lung. Baseline drug and treatment costs (in US dollars)were calculated for the average US adult male on the basis of the payment allowance in the 2013 Medicare Part B average sales price (ASP) drug pricing files. Costs were extrapolated for a treatment period of 6 months.
  
  
  RESULTS
  Of the 62 regimens included, the 6-month mean cost of chemotherapy was $26,989 ± $29,971, and the median cost was $9,611 (interquartile range, $6,305-$39,383). The mean cost of metastatic cancer therapy regimens (n = 32) was $35,315 ± 32,962 compared with $18,107 ± 23,873 for curative therapy (P = .02). Of the 13 regimens with biologics used, the mean costs were $77,278 versus $13,646 for 49 regimens that did not use biologics (P<.001). The cost differential between extremes of costs for regimens with presumed similar efficacy was $90,843 ($79,165 for curative therapy and $90,210 for metastatic cancer therapy). The highest cost differential was noted in breast cancer regimens at $71,041 for metastatic cancer therapy and $63,926 for curative therapy.
  
  
  CONCLUSIONS
  A significant cost differential exists between chemotherapeutic regimens for the most common solid tumors. Incorporation of costs and incremental effectiveness in current guidelines may encourage socially responsible practice patterns.
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: Hasan
authors: H
authors: Nadeem
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: Thejus T
authors: TT
authors: Jayakrishnan
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: Rahul
authors: R
authors: Rajeev
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: Fabian M
authors: FM
authors: Johnston
authors: Medical College of Wisconsin, Milwaukee, WI.
authors: T Clark
authors: TC
authors: Gamblin
authors: Medical College of Wisconsin, Milwaukee, WI kturaga@mcw.edu.
authors: Kiran K
authors: KK
authors: Turaga
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics; D008297:Male; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000191:economics