Cost of cancer is a hard pill to swallow

Lauren Terrazzano | Life, With Cancer

December 12, 2006

The pills I hoped would help save my life were small and brown. There were 30 of them, all told, and they looked like Advil.

That was where the similarity ended.

At $1,800 a bottle, a month-long supply cost more than my first car.

I picked them up at twilight at a pharmacy a few blocks from the hospital where I would begin my lung cancer treatment. It was more than two years ago, but I remember the moment clearly, and how I guarded the pills in my purse as if they were diamonds.

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Cancer is not cheap. Yet I am one of the so-called lucky ones.

I have health insurance that covers most of my treatment, including those pills. A half-million others fighting the disease have no health coverage, or are underinsured. Beyond its emotional and physical tolls, cancer costs America nearly $207 billion a year in medical care, research, and loss of productivity.

To put that figure into context, look at it this way: The Iraq war has cost the United States $400 billion since 2003. Domestic cancer spending on treatment and research is six times what the federal government spends yearly on education. If cancer could somehow be eradicated, the money spent each year on the disease would be enough to provide health care to all uninsured children in the United States for a decade.

The high cost of cancer - which kills a half-million people a year in this country - is distributed in part among hospitals and health insurers, but the government funds a lot of it. Part of the reason the cost is so steep is that for the uninsured, early screening rarely happens. "People who don't have insurance are diagnosed at a much later stage when it is less treatable and more expensive... to treat them," said Lisa Daglian, a spokeswoman for the American Cancer Society.

Through higher insurance premiums and even taxes, everyone ends up bearing the cost. That includes the expensive drugs, sophisticated imaging, and even the heaven-sent nonadhesive tape that keeps your IV in place without the torture of eventually ripping your skin off along with the bandage.

Those pills I was taking, called Iressa, had recently been approved by the Food and Drug Administration. For three months, I took them daily as part of my aggressive chemotherapy regimen at Memorial Sloan-Kettering Cancer Center.

Still, some people never get to choose a drug like Iressa. Twelve percent of uninsured cancer patients are younger than 65 and without Medicare benefits, according to the American Cancer Society, denying them basic choices on where and how to be treated. With a disease that often gives its victims so little control, having choices is priceless, I've found.

But be assured, there is always a price.

If you want a more personal lesson in the economics of fighting the disease, look at the hundreds of pages of hospital bills and insurance statements I have amassed.

Let's start with the hug.

Two days after complicated surgery to remove my right lung, a hospital psychiatrist appeared, unsolicited, in my 14th floor room. Lovely and soft, the therapist gave me a supportive embrace as I sat, somewhat glazed over by morphine. Reviewing medical statements months later, I discovered that the hospital billed Blue Cross and Blue Shield for what I thought was just a friendly visit. It was indeed friendly. But the meeting lasted all of 10 minutes and was charged as "individual psychotherapy" to my carrier.

My husband and I call it the $225 hug.

To be fair, my surgeon also gave me a hug after the surgery. He didn't charge me for it, but the hospital billed my insurers $21,035 for the operation.

My insurance statements have all sorts of names on them of physicians and technicians I've never met.

Sloan Kettering, whose costs are comparable to other cancer centers and hospitals, has some of the best minds in the world playing a daily game of chess with the disease. Doctors with first names like Robert, Ravinder and Fred are listed on my hospital bills, though I've never met them. These radiologists analyze my CT scans every three months to detect the slightest changes in my body. Each reading they do costs my insurance company $535. A sophisticated test known as a PET scan, which detects and traces tumor growth through nuclear imaging, costs about $2,900 a pop. I've had at least five of those over the past two years.

Radiation treatments during the summer were about $1,300 a day for 30 days straight. My latest chemo regimen was about $10,000 a session, every three weeks. I only did two.

As for the brown miracle pills I treated like diamonds, they were indeed gems for some but didn't have the desired effect on my tumors. Responding to the pharmaceutical company's own clinical trial of Iressa, the FDA ultimately questioned its effectiveness at prolonging life and the agency and drug company together limited its use to those who have had success with the drug.

This is one of the reasons cancer is so expensive. For many of us trying to find an effective treatment, there has to be a better way.