Wednesday, February 16, 2000
Insurer backs off cancer payments
The New York Times and The Cincinnati Enquirer
One of the nation's largest insurers has decided to narrowly restrict payment for a grueling and controversial breast cancer treatment that has not been proven to work.
The company, Aetna/US Healthcare, has been informing doctors that it will no longer provide reimbursements for the treatment — bone marrow transplants for women with breast cancer — for its 1.6 million members.
The decision comes in the wake of a finding that a university doctor in South Africa had falsified data that seemed to indicate the transplants were more effective than a standard treatment. That finding contradicted the results of four other independent studies, which found no improvement in survival rates for patients who received the experimental procedure. With the South African study discounted, the findings of the other four studies remain uncontested.
The company will continue to cover bone marrow transplants for illnesses where studies have proven their efficacy, such as leukemia. Aetna will also cover women enrolled in federally sponsored studies of the transplants that are designed to determine whether variations of the treatment are effective.
What that means is that women covered by Aetna who qualify and are willing to participate in federally sanctioned clinical trials will still be able to receive transplants. Other patients will not be reimbursed.
Even before Aetna U.S. Healthcare changed its policy on covering bone marrow transplants for women with breast cancer, Tristate doctors had been backing off the controversial treatment.
Jewish Hospital in Kenwood — the only hospital in town that does bone marrow and stem cell transplants — treated at least 40 women with breast cancer in 1998 but just 15 in 1999.
“The numbers have dropped off dramatically,” said Dr. Randy Broun, director of the stem cell transplant program at Jewish Hospital. “Referring doctors have pretty much made the decision for us by deciding not to refer as many women.”
Cancer researchers, insurers and consumer groups have been debating for several years whether breast cancer patients who get massive doses of chemotherapy do better than those getting lower doses. Without a bone marrow transplant — an expensive, often hard-to-endure treatment — high-dose chemotherapy would be lethal.
Until now, thousands of women nationwide, including some in Greater Cincinnati, had been getting bone marrow transplants without participating in clinical trials.
“For those patients who've already gone through a bone marrow transplant, this does not mean they will automatically have a recurrance,” Dr. Cody said. “It means they won't have any better chance of a cure than traditional chemotherapy.”
About 10 to 20 percent of women with advanced or metastatic breast cancer survive five years after treatment, Dr. Cody said.
Other insurers said they planned to continue to pay for bone marrow transplants for women who want them.
“The decision about treatment would be between the patient and the doctor,” said Dr. Lee Newcomer, senior vice president for health policy at United Healthcare, which insures 13.5 million Americans.
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