Rx Minute: CBO Recognizes Offsets & Genetic Basis of Breast Cancer

CBO Announces a Change to Scoring Methodology

February 2013

CBO Recognizes Offsets Provided by Medicines

In a recent report, the Congressional Budget Office (CBO) announced a change to its scoring methodology that explicitly recognizes the beneficial impact prescription medicines have on reducing other health care spending.[1]  Specifically, in estimating the financial impact of future legislation affecting prescription drug use among Medicare beneficiaries, CBO will assume that a 1% increase in the number of prescriptions filled results in a 0.20% decrease in spending on medical services. 

CBO’s analysis relied on new research presented in eight studies that demonstrate a link between changes in prescription drug use and changes in the use of and spending for medical services. These include studies that look at the impact of pharmaceutical policies on both Medicare beneficiaries and the broader population outside of Medicare, as well as studies that compared medical expenditures by Medicare beneficiaries before and after the implementation of the Medicare Part D benefit.

While this new finding is currently confined to proposed legislation that alters drug utilization in Medicare, the CBO indicated a number of areas where it may find additional or larger offsets in the future, provided an evidence base develops to support such a conclusion.

Promising Research on the Genetic Basis of a Difficult–to-Treat Form of Breast Cancer

A recent study found a potential new target for a particularly challenging form of breast cancer.[2]  So- called triple-negative breast cancer is particularly difficult to treat because it lacks the three treatment targets important in other forms of the disease. Progress in the understanding of the genetic basis of this particularly aggressive form of breast cancer may pave the way for developing personalized therapies for patients and offers new hope for those suffering from the disease.

While chemotherapy and subsequent surgery have a favorable outcome for 30% of triple-negative breast cancer patients, outcomes are almost universally poor for patients for whom residual disease is found at the point of surgery.

By examining residual tumor tissue from 114 women, the Vanderbilt University researchers were able to determine that 90% of patients with residual disease following chemotherapy treatment had mutations in five well-known biological pathways.

These findings, which were presented at the San Antonio Breast Cancer Symposium, are significant as the five pathways already have medicines either on the market or in development for other forms of cancer and may be targeted in future clinical trials to produce new personalized treatments for triple-negative breast cancer patients.


[1] Congressional Budget Office, “Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services,” November 2012, available at:http://www.cbo.gov/sites/default/files/cbofiles/attachments/43741-MedicalOffsets-11-29-12.pdf.

[2] Balko JM, et al "Profiling of triple-negative breast cancers after neoadjuvant chemotherapy identifies targetable molecular alterations in the treatment-refractory residual disease" SABCS 2012; Abstract S3-6. As reported by M. Smith, “Gene Study in Triple-Negative Breast Cancer is Positive,” Medpage Today, 7 December 2012.http://www.medpagetoday.com/MeetingCoverage/SABCS/36331

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