A Hard Look at the Cost of Cancer Therapy

Not too long ago I heard the story of a family in my neighborhood who is dealing with a heartbreaking encounter with cancer. The parents are only in their thirties and have young children at home. The mom is experiencing a recurrence of cancer they thought she had beaten. As recurrent cancers often go, it is very aggressive with metastases at multiple sites. From the details I have heard, there is virtually no chance at a cure. Terrible situations like these tend to reach right down into our soul and touch us with almost primal emotion. While this emotion allows us to form a human bond with those suffering from such a terrible disease; I also think it also blinds us to the realities of cancer therapies, their costs, impact on society, and impact on those receiving treatment.

Many of the new “breakthrough” cancer therapies would not receive much attention if the thought of cancer was not so closely tied to our collective emotions. If instead reason and rationale were the only two driving forces within us, we would never agree to pay tens of thousands of dollars for therapies that have not shown the ability to deliver impactful outcomes. A number of the latest agents to treat cancer can only be shown to provide a modest benefit in progression-free survival with no effect on overall survival. Others may show small improvements in overall survival measured only in days or weeks. Despite this lack of convincing outcomes, our health care system is currently paying costs similar to a nice used car per month per patient for some treatments because we have allowed our emotions to keep us from saying no.

I am in no way advocating that we halt research on cancer therapies, deny treatment for all cancer victims, or stop dreaming for the day we can cure cancer for all. I would love to see that day. I do; however, believe that we need walk carefully as we continue down that path. With the overall increase in drug costs seemingly on everyone's mind, and the nearly unsustainable nature of some specialty drug pricing, we need to ensure we do not allow the emotions attached to a disease like cancer to contribute to the destabilization of the economics of drug therapy. 

I think we need to collectively stop and take a hard look at the way we determine coverage of cancer therapies. I do not believe that solely being diagnosed with a FDA approved or a National Comprehensive Cancer Network recommended indication is enough justification for coverage of all cancer therapies. We simply cannot afford to leave out the cost consideration any longer.

Countries with single-payer health systems have been forced to tackle these types of concerns head on for a while now. For example in the United Kingdom, the National Institute for Health and Care Excellence (NICE) uses a cost per quality-adjusted life year (QALY) to evaluate whether a therapy should be covered. Sweden has a national board that evaluates a medication’s cost-effectiveness and can reject it from coverage if the cost is deemed too high for the benefits provided. If rejected, the manufacturer can choose to resubmit with a lower cost to provide enough value to the health care system. While none of these approaches is perfect, or the instant answer for us in the United States, we can use these kinds of examples as a place to start our discussion.

We will need to find innovative ways to evaluate the cost-effectiveness of cancer therapies to help us choose what therapies we can afford to cover. This will require cooperation between all interested parties: patients, providers, payers, and society as a whole. Although this will require a lot of work, I believe the
time is right to begin these hard discussions so we can ensure the long-term economic stability of treating cancer. 

Those of us within managed care can, and in my opinion should, be on the leading edge of talking about this uncomfortable issue. This is not a problem we can solve overnight, but it is a problem we can choose to start discussing now. We have the relationships with drug manufacturers to communicate that the plans we represent cannot shoulder the increasing costs of cancer therapies much longer. We can begin to reach out publically to help start this discussion within our society. 

This is a problem we should not turn a blind eye to and I hope we will reach up and begin to make sure the treatment of cancer does not contribute to any financial instability within the health care market.