What do cancer treatments cost?

The shameful answer is most of don’t even know what each component costs. And there are many components.

This question has come up during my informal consultation with friends and relatives who were grappling with the difficulty of having a parent go through cancer treatments several continents away. They couldn’t leave their jobs for an undetermined length of time to go take care of them in their native countries. The elderly parent couldn’t be insured for cancer treatment if they were brought over to the United States. So if they were to consider bringing them over, they wanted to know what the treatment would cost. 

First, there is the cost of the consultation, which is made up of two components: the physician fee and the facility fee. Add on the cost of baseline tests: blood work, x-rays, CT scans. A biopsy would be done for confirmation of the diagnosis, which would include procedure costs (professional and facility costs) and pathological examination of the tissue. We haven’t gotten to the treatment part yet.

I picked a standard drug regimen, to see if I could find out the cost of delivering the treatment at our Cancer Center. It is a commonly used combination, so I started with our Pharmacy department. We have billing codes, but it was difficult to tease out what we got paid.  They could find out what they charged, but not what we got paid. It was impossible to add on the cost of the infusion chair time, the nurse, the intravenous tubes and needles. One could have gotten the cost of the prescription anti nausea medications and antibiotics from the local retail pharmacy. And if there were any complications, one would have to add on the cost of an emergency room visit or hospitalization. And this was just one cycle of chemotherapy. Multiply that by 6, or more, if those were the number of treatments required. I could not come up with an estimate.

As we get into more biologic therapy, and targeted designer drugs, just the cost of the drug alone can be $5-20,000 a month. Treatments can last for 6 months to more than 3 years.  We have been fortunate to have an insurance system that covers the expense for most people, but we should at least know what it costs, and what benefit it buys.

 I assume Insurance companies would have been able to provide me the cost per cycle, since they pay the bills. Our business department is  just making sure that we get paid for the services provided.

But we are doing the prescribing, and we should know. We should be able to provide that information to our patients, if they want to be informed patients. And they need to be. As more chemotherapy shifts to oral formulations, or more co-pays are shifted to the patients, it behooves them to pay attention. The designer drug that is added to standard chemotherapy in their terminal cancer may buy them less than an extra week of life. This is not rationing; this is called using limited resources wisely.  We have a lot of fantastic new treatments that are being developed; we will have to find a way of paying for them without breaking the system.

George H.W. Bush was thought of as out of touch because he didn’t know what the price of a gallon of milk was. He had probably not bought a gallon of milk for himself for years. But we do prescribe treatments every day. It is shameful that we don’t know.

 McDonald’s has to post calorie counts for their food items. We should have access to the knowledge of what cancer treatments cost.