Drug Prices Play Central Role in Cancer Treatment Value Decisions

Increasing exposure of patients to actual drug prices, through reduced insurance coverage, has made cost a necessary factor in cancer treatment value discussions, argued Peter P Bach, MD, MAPP, director of the Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center (MSKCC), at the 2016 San Antonio Breast Cancer Symposium.

Determining the value of cancer treatment regimens is an ongoing endeavor of the Drug Abacus project at MSKCC, which was founded by Dr Bach, as well as the driving force behind other initiatives including the American Society of Clinical Oncology Value Framework, the European Society for Medical Oncology Magnitude of Clinical Benefit Scale, the National Comprehensive Cancer Network Evidence Blocks, and the Institute for Clinical and Economic Review evidence reports.

In a plenary lecture, Dr Bach explained the factors that influence escalating drug costs, how these costs are tied to value, and the effect these developments are having on patients.

Drugs account for approximately 19% of spending in health care, as well as the fastest rate of growth in health care spending over the last 3 years. This is a result of increasing launch prices for new drugs, the introduction of new drugs in large markets such as hepatitis C, and rising prices for older drugs such as EpiPen. At the same time, these increases in drug costs are accompanied by decreases in drug value. A new drug costs approximately $50,000 per life-year 20 years ago. Today, a new drug costs approximately $250,000 per life-year.

Dr Bach discussed the impact these trends are having on patients with cancer who need expensive drugs for their treatment. He cited a report that the proportion of patients who are exposed to more than one-third of a drug’s actual cost grew from 37% to 63% between 2014 and 2016. This is a result of changes in health insurance coverage, which have increased the prevalence of high deductible plans and increased out-of-pocket prescription costs. This in turn has adverse effects on patients health: Dr Bach pointed to a recent study showing that patients with chronic myeloid leukemia who had to pay out-of-pocket for a tyrosine kinase inhibitor initiated treatment a median of 60 days later than patients who received cost-sharing subsidies.

Aside from relying on market forces to resolve high prices, Dr Bach suggested two alternative solutions. The first is implementing outcomes-based pricing, which is the goal of Dr Bach’s Evidence Driven Drug Pricing Program at MSKCC. The second is allowing patients to consider costs alongside other information about drugs to inform their decisions. As Dr Bach contends, “the price should be dealt with as a feature of the drug, like its toxicity or its potential benefits.”—Zachary Bessette