How much will this cost?

[UniJeff]

I just had my orchiectomy a few weeks ago. No bills yet. Upcoming I will have RLND and/or chemo. I'm T1N0M0 mixed Germ cell: Embryonal, Yolk Sac, and Chorio.

What should I expect as ballpark prices for the Orchiectomy, RLND, and basic Chemo. I have good insurance but will be paying 20% out of pocket for each and have no idea how much this will cost. (I'm in FL if that makes any difference)

[dadmo]

Jeff:
First understand I'm not a doctor but I do have some questions. Has surveillance been ruled out? With the combination of cancer components in your tumor I'm not sure an RPLND would be curative. Have the doctor's talked at all about adjuvant (reduced cycles) chemo?

[UniJeff]

Surveillance is an option, I just wasn't too worried about that cost. Although with all the testing maybe I should consider that cost too. Cost won't be a deciding factor, I'm just trying to plan accordingly.

I had my Orchiectomy on 12-16-09. Right now we're waiting 5 weeks to do the next blood test to see what my AFP and HCG levels are. (I was thinking about posting a question about the timing on that in another thread.) The urologist mentioned that surveillance, RPLND and chemo are options and we'll discuss further when we get the next blood results. He didn't use the word adjuvant, he just said the chemo would be ~ 4 months in duration.

Prior to surgery AFP - 112, HCG - 106, LDH - normal

[Paul54]

Jeff:
Sorry to welcome you aboard.
With elevated markers like yours, it would be prudent to retest every one or two weeks. Hopefully they will decline, but if they are increasing, you shouldn't wait 5 weeks to attack with chemo.

I agree with dadmo that RPLND would be the least favorable choice. If the tumor markers do decline to normal levels, surveillance or shorter courses of chemo (adjuvant) are good options. Adjuvant chemo (2 cycles of BEP) would last 6 weeks. The most aggressive chemo attack for proven metastisis would be 4xBEP or 12 weeks. I'm not sure where 4 months would come from.

Estimating costs is tricky. Providers such as hospitals, imaging centers, doctors, etc. all have "list" prices. Insurance companies negotiate contract prices, which the providers have to accept. It's a game like car sticker prices. For example, a CT scan may list for $1600, the contract price could be half of that, so your share might be 20% x $800 = $160. I was shocked to see how little physicians net for an office visit so it's no surprise they try to spend a few minutes with each patient.

Most importantly, you should be refered to an oncologist. Push for it. Oncs would understand why you need tumor marker tests ASAP to get more data points on the direction of levels.

Good luck. Let us know how it goes.

[UniJeff]

Thanks Paul.

I scheduled myself a consultation appointment with an Oncologist next Friday (earliest they could get me in with rush after holidays).

Here's a little more background. Chest x-ray was clear, CT scan showed a single questionable lymph node and a "too small to characterize lesion" on the liver. PET scan came back all clear. Also the path report showed "no unequivocal evidence of lymphovascular invasion".

I don't know if any of that info drives the five week wait (7 weeks from date of orchiectomy). Anybody else think that the waiting 5 more weeks is cause for concern?

[gilly6993]

I started chemo over 6 weeks after my I/O....I did not however have any markers or positive RP nodes....just an inguinal node, and that went away before treatment....as far as waiting 7 weeks form the surgery I don't think it is that big of a deal but each case is different....

[Paul54]

I started chemo over 6 weeks after my I/O....I did not however have any markers or positive RP nodes....just an inguinal node, and that went away before treatment....as far as waiting 7 weeks form the surgery I don't think it is that big of a deal but each case is different....

I agree on the chemo timing. But since his AFP and HCG were both over 100 before the I/O, I think they need to know which way they are going within a week or two. If they are increasing, then there isn't any reason to wait that very long. To the contrary.

[Scott]

While these sources won't give you exact price tags, they may give you a ballpark sense:

http://www.kantrowitz.com/cancer/costs.html

http://tcrc.acor.org/costs.html

[UniJeff]

Thanks Scott! Looks like I'll have no problem hitting my out of pocket max on insurance. That gives me enough info to get a rough range on how many co-pays I'm looking at as well.

[dano]

cost significantly more than that...

I had the orch. in October and RPLND in December... costs leading up to and following the orch. were 40k+ (including ultrasound, 1 night hospital because of internal bleeding and post op scans). The RPLND and all that was involved has topped well over 100k. I hit my maximum out of pocket early on and am now just watching the claims/bills pile up. This is what health care is for! Make sure you're proactive about following up with claims and billing though- it might be worth so phone calls to make sure that hospitals and your health care are working together.

Dano

[Vaness(Aless)]

heya,

ale also started chemo (adjuvant 2xBEP) 7 weeks after his orchiectomy, but at 6 weeks he was re-staged (markers, CT, xray) to make sure he was still at the same stage.

good luck, let us know!

[Vinny]

Here's some examples from my history.

Negotiated price (after insurance discount):

Orchiectomy $2,200
4xBEP, including miscellaneous scripts and Neulasta injections $45,000 (the Neulasta shots were about $12,000 in total)
CT scan and radiologist fee $1,600
RPLND (@ IU, including inpatient stay) $25,000
Surveillance visit (including tumor markers) $200 - $250

[tcelano]

TC Costs

Wow, Vinny, where do you live? My orchiectomy cost at least $10,000 in Portland, OR. I think the bills from the Anaesthesologist alone came near $2,000. The surgeon only charged me around $600, but the hospital charge was over $8,000. The good news is that they did a good job...

I am at the end of the first of three cycles of BEP. I don't know how much this is costing yet, but I'll visit back here to update when I get some bills.

[chemo boy]

(the Neulasta shots were about $12,000 in total)

WOW...prices realy do vary. I was treated at DFCI and the Neulasta shots were $14,049 EACH!!! for a total of $42,000 +\- for just the Neulasta alone I'm sure that this was negotiated down by my insurance company.

I was given the option of getting the Neulasta injections at my drugstore, for self injectiion, and the price would have been nearly $6,000 each shot!

I guess it makes more dollars the sense

Rich

[chemo boy]

Ooops!

I didn't read that Vinny's totals were the negotiated price. Who knows what they were to start.