The costs for many new cancer therapies have skyrocketed in just the past 5 years and some new immunotherapies come with very high price tags. Veena Shankaran, MD, of the Univeristy of Washington and Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center in Seattle, WA, said the problem is not only the high costs of many new therapies but the issue of financial literacy.  

“The problem is multifactorial, and has to do in part with the high cost of emerging cancer drugs and the increased cost-sharing that many patients with employer-based health insurance plans are experiencing. Added to this is a lack of transparency about costs, lack of financial literacy resources in many clinics, and the urgency/chronicity of cancer therapy that makes it difficult for patients with cancer to back away from care or spend more judiciously,” Dr. Shankaran told Cancer Therapy Advisor.


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It is hard to know exactly whether the treatment-related  financial hardship causes poorer quality of life, or whether the patients who  are at greatest risk for financial hardship before diagnosis (ie, lower  household income) are already dealing with issues that might affect their  quality of life at diagnosis and during treatment.

“We did a population based study of financial hardship among patients with colon cancer and found that about 48% of patients reported  significant financial hardship during treatment,” said Dr. Shankaran,2  “I think this issue Zafar and colleagues describe is a large-scale and underappreciated problem.”

Cancer costs are increasing more rapidly than ever before and the rate of the trajectory is simply unsustainable. “Immunotherapeutics are not solely to blame as this escalation in costs started with targeted therapies,” explained Ronan Kelly, MD, MBA, of Johns Hopkins Medical Center in Baltimore, MD.

“The most glaring example is that of imatinib. A year’s supply of imatinib has increased from $30,000 in 2001 to $92,000 in 2012.  If the 2001 price was set to generate a reasonable profit and to recoup research and development costs then it is difficult to justify a 3-fold increase in the price over a 10-year time period.”

RELATED: Coping Strategies Common for Cancer-Related Financial Distress

The effect that medical insurance has on the value equation is termed “moral hazard” and until recently patients were insulated from feeling the effects of rapidly escalating drug prices. Dr. Kelly said with copayments and deductibles expected to continue increase there will be an increase in consumer price sensitivity.

“I have recently completed a study at Johns Hopkins and patients are indeed very concerned about higher copayments,” said Dr. Kelly. “I and others have repeatedly called for a value-based pricing system to be introduced. [The American Society of Clinical Oncology (ASCO)] has initiated a dialogue amongst key stakeholders in an effort to enhance value as defined by the optimal clinical benefit per unit cost. The ASCO Value in Cancer Care Task Force is currently in the process of developing an algorithm to determine the relative value of cancer drugs.”

The first therapies being evaluated for cost-effectiveness include those for advanced non-small cell lung cancer, prostate cancer, and multiple myeloma.

An approach that aims to help define the clinical benefit for a given treatment as defined by overall or progression-free survival in addition to the quality of life improvement.

References

  1. Zafar SY, McNeil RB, Thomas CM, et al. Population-Based Assessment of Cancer Survivors’ Financial Burden and Quality of Life: A Prospective Cohort Study. Journal of Oncology Practice. December 16, 2014. [Epub ahead of print] doi: 10.1200/JOP.2014.001542.
  2. Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol. 2012;30(14):1608-1614.