Cancer Medicines: Adding Value to the Cost Equation

Cancer Medicines: Adding Value to the Cost Equation

04.24.14 | By Randy Burkholder

ASCO logoIt's conference season! Here's an important one: The American Society of Clinical Oncology’s (ASCO) annual conference is around the corner and is a platform to reflect on the value of cancer treatments for patients, and also address some of the concerns that have been raised around the cost of medicines. We've been engaged in discussions over the last two years around the critically important topic of sustaining progress against cancer in a cost-containment environment, including through participation in the Turning the Tide Against Cancer initiative, and we feel that it's a vital time to be part of that dialog. 

The questions on cost and value are important, but they miss the opportunity to reach consensus, patient-centered solutions. Here's four places the discussions focused on cost often run amiss: 

1) The need to put treatment costs in context: Cancer spending as a percentage of overall health care spending has remained stable at approximately 4-5% over the past 30 years.  According to recent data from IMS Health, spending on oncologic medicines represented less than 1% of total national health expenditures in 2012.  Chemotherapy and related drug costs represent about 20% of cancer spending – when examining cancer costs, it’s important to consider the entire continuum of care.

2) A fairness framework won’t get us where we need to go, because it won’t answer what patients need. In the United Kingdom, the National Institute for Health and Clinical Excellence, which uses a centralized cost-effectiveness standard, rejected coverage of every cancer medicine it reviewed last year. This arguably meets the fairness standard – each Brit had equal denial of access – but is it desirable? Also worth noting – five-year relative survival rates for cervical, breast and colorectal cancer are notably higher in the U.S. (67%, 90.5%, and 65.5%, respectively) than they are in the U.K. (59.4%, 78.5%, and 51.6%, respectively).

3) We can’t speak to patient concerns about cost while ignoring the issue of disproportionate patient cost-sharing for cancer medicines.

The purpose of insurance is to spread the risk of a substantial loss over a large insured population so that sick patients are not burdened with inordinately high costs for life-saving or life-improving treatment. However, in contrast to other aspects of patient care, medicines (including cancer medicines) are often subject to greater cost-sharing, which can lead to treatment abandonment and non-adherence.

4) When considering value, it’s important to recognize the complexity and challenges of assessing the value of individual interventions and communicating that to the patient in a way that is helpful to them.  The value of a medicine typically varies considerably from patient to patient based due to clinical factors (e.g., comorbidities, age, etc.), genetics (variations that influence response to a medicine) and preference (difference patients have important differences in their needs, values and treatment goals). In addition, oncology is a rapidly evolving field in which our understanding of the value of an individual medicine changes considerably over time as new research is conducted, use of the medicine changes in treating a cancer (e.g., earlier in disease stage and line of treatment), and new uses and treatment combinations are discovered.

The good news - there has never been greater hope for patients fighting cancer, because not only are there a wide range of effective oncology medicines currently available for patients, there are also more than 900 cancer medicines and vaccines in the biopharmaceutical pipeline.  If you break some of the pipeline numbers down, 111 potential new treatments are for breast cancer, 117 for lymphoma and 121 for lung cancer.  These numbers evince the hard work by biopharmaceutical research companies on researching and developing new treatment options to beat cancer.

Here's some other facts that show how medicines are making major gains against cancer:

  • Treatment advances for chronic myeloid leukemia has increased 10-year survival from less than 20 percent to more than 80 percent.
  • The five-year survival rate for children with cancer went from 58 percent in the mid-1970s to 83 percent today.
  • The five-year survival rate for lung cancerhas increased more than 50% since 1975. 

ASCO is helping advance high-quality, efficient delivery of oncology care through efforts such as its QOPI quality measures and CancerLinq initiative. We look forward to working them to achieve a future in which continued advances yield major gains for patients and society.

Stay tuned…

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