Insurer to Cover New Cancer Treatment

One of the nation’s largest health insurers has reversed a longstanding policy and decided to pay an estimated $10 million for the care of patients who receive an experimental treatment for breast cancer.

The Blue Cross and Blue Shield Assn. announced that about one-fifth of its member plans have agreed to underwrite the cost of an experimental bone marrow transplant procedure for as many as 600 women who will participate in a nationwide study directed by the National Cancer Institute.

The decision is said to mark the first time a private insurer has agreed to fund studies of an experimental medical treatment.

Outside reviewers have concluded in recent months that the procedure--called “autologous” bone marrow transplant--shows considerable promise. Earlier this year, it received a favorable evaluation by Dr. David Eddy of Duke University, whom Blue Cross-Blue Shield commissioned to review studies of the treatment. And last month, an NCI panel determined that the procedure merited controlled clinical trials.

The insurer’s decision also follows a series of lawsuits around the nation in which patients demanded that Blue Cross-Blue Shield pay the cost of the treatment, which ranges from $100,000 to $150,000.

Cheryl van Tilburg, a spokeswoman, said the Chicago-based insurer has faced more than a dozen such cases over the last three years and has lost more than half of them. “There are doctors who believe . . . this is the best therapy, and others who have reservations,” she said.

Unlike the more familiar transplant procedure in which a patient receives bone marrow from a donor, an autologous transplant entails removing and storing as much as a quart of the patient’s own marrow.

Women in the NCI trial will then receive very strong concentrations of anti-cancer drugs. The doses are so high that they also kill healthy bone marrow, which produces blood cells. When the chemotherapy is completed, the stored marrow is returned to the patient.

Bruce A. Chabner, director of the NCI’s cancer treatment unit, said a preliminary trial of the procedure at Duke found that 90% of women who received it showed no sign of a relapse three years after treatment. Women in the study had cancers that involved 10 or more lymph nodes but that had not spread to other organs.

So far, Blue Cross-Blue Shield plans in New York City, Massachusetts and New Jersey, among others, have decided to pay for treatment in the NCI study.