Renal Cell Carcinoma: Cost of Treatment May Negate Impact of Treatment Advances

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Access to treatment should be considered as important as the research leading to clinical improvements.
Access to treatment should be considered as important as the research leading to clinical improvements.

A new study adds to the growing body of evidence that insurance status and high out-of-pocket costs can pose serious financial barriers to cancer treatment, limiting access to therapies and, consequently, increasing the potential for negative consequences for overall survival.1

The study by researchers at the University of Pennsylvania and the Fox Chase Cancer Center in Philadelphia focused on 1721 Medicare patients with metastatic renal cell carcinoma (mRCC). It found that almost 40% fewer with high out-of-pocket costs initiated oral therapy compared with those with low out-of-pocket costs.

“This is especially relevant for the treatment of metastatic renal cell carcinoma,” they wrote, because of the discovery of many new, but expensive, oral therapies available to mRCC patients.

“These expanded treatment options have demonstrated reduced toxicity and been shown to extend survival in clinical trials, more than doubling the median overall survival of approximately 1 year conferred by pretargeted era therapies.”

The study compared the treatment initiation rates of Medicare Part D patients who received low-income subsidies (LIS beneficiaries) to their non-LIS counterparts. The difference in out-of-pocket costs was significant: at least $2800 for the initial oral prescription for non-LIS patients, compared with $6.60 or less for subsidized patients.

Barely one 1 of 5 patients with the higher out-of-pocket costs (20.7%) initiated oral therapy, whereas more than a third of the LIS patients did (33.9%). The non-LIS patients, furthermore, demonstrated lower rates in initiating any targeted therapies (26.7% vs 40.4%).

Even when they did initiate treatment, the authors wrote, “non-LIS patients were also slower to access therapy.”  

Patients with mRCC are hardly the only patient group affected by treatment costs. In its 2016 report on the State of Cancer Care in America, the American Society of Clinical Oncology (ASCO) stated that “costs associated with cancer care are rising more rapidly than costs in other medical sectors.”2

Cancer drugs, the report stated, “account for seven of the 10 most expensive drugs reimbursed through Medicare Part B.”

For the Medicare Part D program, the Centers for Medicare & Medicaid Services (CMS) paid $1.35 billion for a single cancer drug — lenalidomide — in 2013, “making it one of the 10 most expensive drugs that year despite being used by many fewer beneficiaries than competing drugs on list.”

The impact on patients can be financially devastating, which led a nationwide consortium of physicians to make a public call for lower prices in 2015.3

“For a patient with cancer who needs one cancer drug that costs $120,000 per year, the out-of-pocket expenses could be as high as $25,000 to $30,000 — more than half the average household income and possibly more than the median take-home pay for a year,” they wrote. “Patients with cancer then have to make difficult choices between spending their incomes (and liquidating assets) on potentially lifesaving therapies or foregoing treatment to provide for family necessities (food, housing, education). This decision is even more critical for senior citizens who are more frequently affected by cancers and have lower incomes and limited assets.”

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