Increasingly, Dr Olszewski found, patients treated with expensive oral anticancer agents rely on support from charities to offset the cost and maintain their regimes. In a retrospective study published in February, Dr Olszewski and a group of colleagues examined pharmacy records for 1557 prescriptions filled between January 2014 and March 2017.4

“Charity assistance was used for the first prescription by 36% of patients and was strongly associated with upfront out-of-pocket requirements,” the study found. “Charitable funds covered 64% of all required out-of- pocket expenses.”

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The therapies included tyrosine kinase inhibitors, immunomodulatory drugs, novel antiandrogens, proteasome inhibitors, histone deacetylase inhibitors, and other targeted agents. The most frequently prescribed therapies had a median average wholesale price for the first prescription, they found, of $11,275.

The study’s “real-life implications,” the authors wrote, highlight the weaknesses in cancer care in America.

“Charity assistance has become an indispensable resource for patients treated with novel oral anticancer agents in the United States,” they said. “Its widespread use exposes the inadequacy of current coverage policies, which attempt to address the exorbitant cost of these agents through high cost-sharing requirements.”

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The American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO), and others are looking directly at a cost-benefit analysis of cancer therapies. The chairman of ASCO’s Value in Cancer Care Task Force, Lowell Schnipper, MD, chief of the hematology-oncology division at Harvard Medical School in Cambridge, Massachusetts, said the organization’s “Value Framework” seeks to determine the “net health benefit” of a drug by weighing its effectiveness, side effects, and cost.

A 2015 economic analysis noted that when it gained approval for ipilimumab for the treatment of melanoma in 2011, Bristol-Myers Squibb set the price “at $120,000 for a course of therapy. The drug was associated with an incremental increase in life expectancy of four months.”5

“When we value drugs we really need to look at survival as a key endpoint as the most valued endpoint,” Dr Schnipper said, “and drugs that don’t extend survival resources probably shouldn’t be seen as being as valuable as those that do.”