Broader Discussion on Cancer Care Spending Needed

Broader Discussion on Cancer Care Spending Needed

06.10.14 | By

Cancer graphicIf we want to have an honest discussion around cost, we must do so in a way that includes the entire spectrum of cancer care and not focused solely on the cost of cancer medicines.   This was one of the biggest takeaways from the Institute of Medicine (IOM) event yesterday.
First, as we have stated in previous posts on the Catalyst, innovative medicines make up 20 percent of the health care spending pie for cancer, the rest of the pie consists of expensive hospitalizations, doctor visits and other health care interventions.  This is an important point because it seems like 80 percent of the conversations are focusing on 20 percent of the spending.
Second, the National Pharmaceutical Council (NPC) released a report yesterday highlighting that patients can often pay up to 50 percent out of pocket for specialty medicines – medicines that treat complex diseases such as rheumatoid arthritis, Hepatitis C and cancer.  This isn’t necessarily news but if public debates are going to focus on specialty medicines we must not overlook the fact that patients are stuck with extraordinarily high out of pocket expenses for such innovative and personalized treatments, particularly when they often pay less out of pocket for more invasive and expensive procedures.
Third, high cost-sharing can lead to non-adherence and we already know that non-adherence to medicines can lead to poor health outcomes for patients, which can ultimately lead to additional costs for employers.  The NPC report found that the cost to employers of lost productivity due to poor health is 2.3 times as much as the cost of direct medical and pharmacy spending combined.  Other important findings from the report include the following:

  • The effect of drug adherence on workplace productivity has received little attention compared to the relationships between adherence and health, and between adherence and total health care spending.
  • Experts estimate that more than $1 trillion is lost in productivity every year due to chronic disease; a 2012 study determined that medication non-adherence comprises a substantial component of this $1 trillion figure.
  • Specifically, the investigators found that individuals who are adherent with their medications are absent from work between 3.1 days and 7.1 days less than individuals who are not adherent.

Finally, and perhaps most importantly, a patient at the IOM event made a statement that really boiled down what was missing in the debate around value and cost of medicines.  She said it is important to keep in mind that with all of this talk about costs, we must not forget or overlook the importance of future medical innovation.  After all, without innovation, cancer patients would most likely have few effective treatments options and very little hope for survival.
The reality is that the “C” word no longer means a death sentence for many cancer patients.  The death rate for cancer been cut in half since the 1960s in large part due to innovative medicines and survival rates for many cancers have increased dramatically over the last few decades.
The good news is that there is a whole arsenal of groundbreaking medicines that have the ability to transform patient care – remember, many cancers are now chronic diseases that patients can live with, even for several decades.  And, the biopharmaceutical pipeline is full of other promising new oncology therapies that can continue to pave the way forward in the fight against cancer.
One last thought… I believe that whenever there are public discussions around cost and value of medicines we must weigh how certain policies, initiatives or programs are going to impact the future discovery of life-enhancing medicines.  This is an area that requires great attention because while some proposals might look good on their face, there are often great consequences that impact patient access to health care.  This is especially true regarding government-instituted price controls.
More to come on this but in the meantime, check out our new infographic on the left hand side – it showcases the value of innovative cancer medicines for patients.


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