What Does It Cost to Have Cancer?

We all hear that cancer is big business, involving expensive treatment, but how expensive is it exactly?

I was recently reviewing my medical expenses for last year and was shocked at the numbers. I decided to share them to give my readers an idea of what cancer treatment can really cost. Keep in mind that this is nine months of treatment for early-stage breast cancer in a 40-year old woman with a strong family history. All treatment was provided at cancer centers in the San Francisco Bay Area.

Total cost of care billed:  $224,725
Total paid by insurance: $134,110
Total paid by patient: $5,706

Includes: screening and diagnostic tests, genetic testing, predictive (Oncotype-DX) testing, surgery (lumpectomy, sentinel node biopsy, additional breast biopsy), four rounds of Taxotere/Cytoxan chemotherapy, three doses of Neulasta, two doses of Arinesp, setup and treatment for 33 rounds of breast radiation, plus all associated doctors visits.

Does not include: cost of non-injectable prescriptions (my cost was a few hundred dollars for my prescription co-pays), cost of parking at the medical center (also hundreds), my hypothermia mitts and slippers, and any over-the-counter drugs to help with treatment side effects.

I think we can agree that $224,725 is a lot of money! If you add the amount I paid to the amount that insurance paid, you'll see that the cancer centers received about 62% of what they billed. In some cases, insurance paid all of the billing. In most cases, they paid 50-70%. In a few cases, I have no idea how the provider is able to operate, as insurance paid only 15% of the billed amount!

The reason that I did not pay more than $5,706 is that, like most medical insurance, my plans specify a cap on what I pay out in one year, called "maximum calendar year out-of-pocket." I have a PPO (preferred provider plan), so there are two numbers for this: one for in-network billing and one for out-of-network billing. Once I reached my max out-of-pocket for in-network billing, I paid nothing for the rest of my treatment that year, unless it was delivered by an out-of-network provider. One expensive test I had done is only offered by an out-of-network provider, so for that one insurance says my share is over $2,200.

Now, these are the figures for my cancer treatment-I can't say whether they are similar to those of other cancer patients. Removing radiation or chemotherapy will drop the total significantly. Changing the chemo drug, dosage, or number of cycles also would affect the cost. If I had body scans, was prescribed a year of Herceptin treatment, or was hospitalized with chemo complications, the totals would be even higher. The type of surgery obviously matters, too. A lumpectomy + radiation costs more than a mastectomy, but reconstructive surgery is an unknown variable.

Even given all the variables that could change the total, looking at my actual figures gives you a ballpark idea of what billing might look like. I imagine that a lot of people would look at these numbers and say, "look how cancer centers are profiting from this disease!" And maybe they are, but I don't know that everyone is profiting.

For example, one of the most expensive tests I had done was the Oncotype-DX. This is a test that I insisted on because I wanted to use it to determine whether chemotherapy was beneficial for my situation. The test analyzes a number of genes from the tumor tissue and uses the results to predict the chances of this cancer metastasizing over the next 10 years. It is very expensive test - as in $3,460! Because not all insurance companies cover it, I had to sign papers letting UCSF know that I agreed to pay for whatever insurance didn't pay, which could be the full amount.

At $3,460 a pop, you would think that the company that provides this test (Genomic Health) is rolling in it. However, tests that analyze gene sequences are expensive to run, and last I checked, Genomic Health was not yet profitable. They were running off of venture capital and struggling with insurance companies who refused to pay because they consider the test experimental (despite the published studies supporting their results). They were working with cancer patients to provide financial assistance where needed, too. So, I don't think they are ripping me off - I just think that at this time, this is a test that is hard to deliver in a cost-effective way.

However, I'm not so sure about chemotherapy. At the dosage I was receiving, each infusion of Taxotere cost over $16,000. Yeah, $16K - no typo there. That's just for the drug, not administration or anything. Now, Taxotere has been used for years...why does it cost so much? I've heard that chemo drugs are a prime profit point for cancer centers, as they can mark up the cost as much as they want. Is that what's happening with Taxotere? Or is it incredibly pricey to process? I don't know, but I confess I am suspicious.

So, the question of who is profiting from cancer treatment and who is not is probably more complex than it seems. No matter what, treatment is expensive for the patient. If I had not been able to be added to my partner's medical insurance last April, my costs would have been enormously higher. As if the shock of a cancer diagnosis is not enough, it's easy to see how a patient can end up financial devastated by treatment costs.

Resources

Medical Insurance and Financial Assistance for the Cancer Patient (American Cancer Society)

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