How much should cancer treatment cost? How much is too much?
Submitted by Dr.Kattlove’s Cancer Blog
This is a question that has been bothering oncologists for several years, but has gotten even more troublesome lately. New drugs are being developed that cost tens of thousands of dollars a year yet aren’t saving or prolonging many lives. I’ve written about this before, but now we are seeing surveys of what other oncologists think.
The latest survey just appeared in “Health Affairs” (January 2010), a journal devoted to articles on the delivery of health care and its cost. The authors surveyed nearly 1400 oncologists from throughout the U.S. and asked them how the high costs of the newer drugs affected their decisions. Their answers made sense, but are troubling.
When asked if cost affected which drugs they would use, 56 percent said it did. Even more startling was that the patient’s co-pay carried more weight, with 80 percent of docs taking this into consideration. Remember, in most insurance plans, including Medicare patients often pay a percent of the cost of drugs; with the big-ticket items this would amount to thousands of dollars.
Two-thirds of the oncologists believed that patients should have access to all cancer drugs, regardless of cost, but that means one-third didn’t necessarily believe this. The effectiveness of the drugs was an issue with 60 percent of the doctors. They felt that the drugs should give good value, which means that it would cost no more than $150,000 for every extra year of life the drugs provided. Cost trumps! Most of the oncologists would discuss costs with their patients at least some of the time but not always. This means that patients could receive drugs that would drain their savings and not even know about it beforehand.
One thing the oncologists mostly agreed on was that they needed help. The wanted help from the government in holding down prices and help from either governmental agencies or non-governmental ones in deciding which drugs were worth their cost. And when doctors ask for governmental intervention, you know there is a problem.
The Brits have developed a process where teams of specialists review new drugs to decide if they are worth buying. Do we want that here or should we just spend and spend and spend? This is a big decision and since Medicare is the biggest spender for cancer care (about half of all cancers occur in the Medicare population– over 65); this is the organization that should lead. This holds true regardless of whether we see any health insurance reform.
Maybe some people don’t want the government “interfering” in their Medicare, but then they pay the price if they get cancer.
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January 23rd, 2010 at 11:21 pm
In hopes to control the high costs of cancer medicine, a new paradigm established a requirement of a companion diagnostic as a condition for approval of new “targeted” therapies.
However, it put such great pressure that the companion diagnostics that were approved often had been mostly or totally ineffective at identifying clinical responders to the various therapies. That is because genomics/epigenomics are far too limited in scope to encompass the vagaries and complexities of human cancer biology.
Although any number of labs and techniques can detect mutant genes, this area of pharmacogenomics was ripe for proprietary tests, invented alongside the drug and owned by the drug developer and/or a partner in the diagnostics field. This business opportunity evolved as more drugs were approved with companion diagnostics.
Unfortunately, the introduction of these drugs has not been accompanied by specific predictive tests allowing for a rational and economical use of the drugs. Patients, physicians, insurance carriers, and the FDA should be calling for predictive tests that allow for rational and cost-effective use of these highly expensive drugs.
Given the technical and conceptual advantages of functional profiling assays, together with their performance and the modest efficacy of therapy prediction based on analysis of genome expression, there is reason for a renewal in their interest for optimized use of medical treatment of malignant disease.