Pharmaceuticals Account for the Majority of Actual Cost of Care from Diagnosis to Death in the Treatment of Ovarian Cancer

Objective: To analyze the actual detailed direct cost of treating women with ovarian cancer who die to their disease.Introduction Ovarian cancer is the most deadly gynecologic malignancy, and presumed most costly [1]. The lifetime risk of invasive ovarian cancer in the US is 1 in 75 (based on 2011-2013 data) and the 5-year survival rate is 47.4% (based on 2008-2014) [1]. In women aged 40-59 and 60-79 years, ovarian cancer is the fourth and fifth leading cause of cancer-related death, respectively [1]. In 2018, there were estimated to be more than 22,240 new cases of ovarian cancer and of those with the diagnosis, over 14,070 will die from their disease [1]. Over the last 40 years, despite advances in surgical technique for primary debulking surgery, changes in chemotherapy (i.e. the use of platinum-based combination therapy, dose dense regimens, or intra-peritoneal delivery), and introduction of targeted therapies, the 5-year survival rate have only marginally increased [1]. In 1975, the 5-year survival rate was 33.6%; based on 2008-2014 data, the 5-year survival rate is now 47.4%. This change is by prolonging the life expectancy of women with recurrent ovarian cancer, not by increasing the cure rate of the disease. Background: While ovarian cancer is not the most common gynecologic malignancy, it is the most deadly, and presumably most costly. The high cost of ovarian cancer is multi-factorial. Methods: We used cost data from our hospitals centers as well as physicians fees to gather every cost associated with taking care of a patient with ovarian cancer from diagnosis to death. This included blood, pharmacy, labs, surgery, physician fees, nursing, radiology, pathology. We did not evaluate charges nor reimbursement, purely direct cost to the study hospital and physicians for the care of these patients. We analyzed the last 10 patients who died of ovarian cancer at our institution. Results: Of the included10 patients, the majority was advanced stage (80%) and of serous histology (70%), the overall survival was 21 months. We found the direct cost to the institution to be $1,132,773 for 10 patients, ranging from $30,611 to $263,514 per patient. The majority of cost (43%) was from pharmacy and the highest single expense was for Bevacizumab, which composed 51% of the total direct cost of pharmaceuticals, and 22% of the cost of all expenses. The remaining cost came from physician services (16%), inpatient nursing unit costs (14%), and the cost related to infusion related services (6%), respectively. Conclusions: We found that cost varies significantly between patients and not unexpectedly, increases with increased survival time. Pharmacy costs ie (chemotherapy) significantly outweighs any other cost, and a significant proportion of cost accrued during the last 30 days of life. The actual direct cost to an institution to take care of a patient with ovarian cancer is approximately $113,277, based on a small sample size. The majority of this cost is for pharmacy and specifically for Bevacizumab. This aspect of evaluating cost should be further analyzed.