Patients, Public, Oncologists Favor Not Paying for Treatments if Inexpensive Alternatives Available

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CHICAGO—What do patients with cancer, oncologist, and the general public perceive as the source of rising costs?

That was one of the questions Keerthi Gogineni, MD, MSHP, of the Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, and colleagues posed during their presentation at the 2013 American Society of Clinical Oncology (ASCO) Annual Meeting. The other: “which proposed solutions to reducing Medicare expenditures do these key stakeholders find acceptable?”

“Lowering health care costs is critical,” Dr. Gogineni noted. “Cancer-related expenditures could exceed $200 billion by 2020 [and] federal budget negotiations have been focused on how to cut Medicare costs.” However, “little is known how patients with cancer, oncologists, and the general public view Medicare costs, sources of high costs, and what they would deem as acceptable measures of cost control,” she added.

Dr. Gogineni and colleagues developed a survey instrument that was used to survey each of the three groups independently between July 2012 and March 2013. A total of 326 adult patients with cancer (representing a 72% response rate), a random sample of 891 U.S. adults (50%), and 245 oncologists (55%) completed the surveys.

Results showed that “the majority thought Medicare spending was a moderate or big problem,” they reported, and “most thought Medicare spending could be reduced without denying anyone health care that really helps them.”

The majority also believed “drug companies' prices and insurance companies' profits were foremost in adding to health care costs” and “to varying degrees, physicians, hospitals, and patients are perceived as sharing responsibility for high costs.”

A majority of those surveyed favored a solution of “refuse to pay when less expensive test or treatment has been shown to work just as well” (patient with cancer, 78%; general public, 86%; oncologists, 90%), or if treatments do not improve survival or quality of life (patients with cancer, 52%; general public, 57%; oncologists, 80%). More than half of the respondents believed patients who can afford to pay more should pay a larger share of their costs themselves (patients with cancer, 56%; general public, 58%; medical oncologists, 52%).

Oncologists were accepting of an independent panel of health experts who would decide which treatments Medicare would pay for based on whether the benefits were worth the costs (64%); however, only 33% of patients with cancer and 46% of the general public agreed with this proposed solution,  Dr. Gogineni noted.

The respondents attributed rising costs to factors such as drug companies charging too much (patients with cancer, 94%; general public, 91%; medical oncologists, 94%) and insurance companies' “high profits” (patients with cancer, 88%; general public, 88%; oncologists, 83%).

Many also believed physicians and hospitals provided unnecessary tests and treatments (patients with cancer, 69%; general public, 81%; medical oncologists, 71%).

Few respondents were willing to refuse to pay if treatment extends life by 4 months or by 2.5 years.

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