Two news items published in the past week point to the yin/yang of cancer survivorship and the high prices of cancer drugs.

imageThe good news: a record number of people in the US are surviving cancer, according to the American Cancer Society. That number is 15.5 million Americans, according to a study in the cancer journal CA.

Note the demographics of cancer survivors:

  • One-half are 70 years of age and older
  • 56% were diagnosed in the past ten years, and one-third in the past 5 years
  • Women were more likely to have had breast cancer (3.5 mm), uterine cancer (757,000), and colon or rectal cancer (727,000)
  • Men were more likely to survive prostate cancer (3.3 mm), colon or rectal cancer (725,000), or melanoma (614,000).
  • Over 65,000 cancer survivors are 14 and younger, and 47,000 are 15-19 years of age.

With long-term cancer survivorship comes a host of issues beyond the clinical: they’re economic, social, psychological.

Cost of cancer meds much higher in US toxicity ASCO June 2016 FTThe drug cost news: in the U.S., the price of cancer drugs is much higher than in other nations, shown in the chart published by the Financial Times on 7 June. The median monthly price of branded cancer drugs was about $8,700 in the U.S., versus $2,600 in the UK, $2,700 in Australia, and $3,200 in China. The research on these prices was presented this week at the annual meeting of ASCO, the American Society of Clinical oncologists.

The US has about 5% of the world’s population but represents one-third of drug revenue — and 50-70% of drug companies’ profits, according to the Chief Medical Office of Express Scripts, Dr. Steve Miller.

Health Populi’s Hot Points: The high prices for oncology products have a side effect that Dr. Leonard Saltz of Memorial Sloan Kettering Cancer Center characterized as “financial toxicity” in this interview on 60 Minutes.  I had the pleasure of participating on a panel with Dr. Saltz last month at the MM&M Transforming Healthcare meeting discussing what’s transforming healthcare in and beyond 2016: the emergence of value-based care which essentially asked the question: “is [the drug, procedure, visit, technology, bed-day] ‘worth it?'”

Value is in the eye of the beholder, and that beholder is the payor: the employer; the health plan sponsor like the VA or Medicare or Medicaid; and, increasingly, the patient, now starring as the health care consumer.

imageTwo novel approaches are being discussed to manage the high costs of cancer drugs and care. Specialty-Based Global Payment is discussed in JAMA this week (issue dated 7 June 2016). Drs. Song and Colla present the Oncology Care Model (OCM) which incorporates global payment, medical homes, pay-for-performance, and aligned incentives across payors. The OCM functions like a Medicare bundled payment for an episode of care and covers spending across the continuum of care. As of the writing of this article, over 450 practices are participating in the OCM. Oncologists are the coordinators of care in this model, akin to primary care doctors’ role in ACOs.

imageA second approach with the lens on the patient-as-payor is presented in Buying cures versus renting health: Financing health care with consumer loans, published in Science Translational Medicine. Here, economics-meets-healthcare with the authors conceiving ‘health care loans’ (HCLs) to cover the gap between what insurance covers and the high deductible borne by the consumer-patient. The “buy vs rent” concept is that “renting” spreads the cost of the cure over years versus paying one lump sum as in “buying” a home. The cost of new therapies which save lives led the authors of this article to conclude, “Considering the extremely large burden of certain disease and the many transformative therapies on the horizon, developing more efficient financing methods is now a matter of life and death.” That’s the ultimate financial toxicity, isn’t it?

8 Comments on Financial Toxicity: The High Cost of Cancer Drugs in the U.S. said : Guest Report 3 months ago

[…] as well. For patients who are dealing with cancer and other serious diseases, people can face financial toxicity – that is the side effect of being prescribed an expensive drug or procedure. I’ll be looking […] said : Guest Report 11 months ago

[…] global scourge impacting health citizens the world over. We need a domestic U.S. conversation on the financial toxicity of new-new cancer drugs, and a global one on sharing the burden of and opportunity for financing innovation to cure cancer […] said : Guest Report one year ago

[…] cure cancer. That prescription is toxic as a side effect to helping us get better. This concept of financial toxicity for cancer patients was first raised by concerned clinicians at Sloane-Kettering Medical Center, who discussed the […] said : Guest Report one year ago

[…] healthcare costs are top-of-mind for patients in the U.S. Financial toxicity is a growing concern among oncologists treating patients with cancer, for example. Doctors and […] said : Guest Report 2 years ago

[…] toxicity” was originally coined by clinicians at the Memorial Sloan Kettering Cancer Center, which I discussed last year here in Health Populi. Dr. Leonard Saltz and colleagues recognized a growing side-effect endured by patients dealing with […] said : Guest Report 2 years ago

[…] But for patients diagnosed with conditions for which there are new specialty drugs, there’s an issue of “tolerability” which differs from the definition used earlier in this post with respect to toxicity of a drug. That is, the financial toxicity of high-cost drugs which can break a family’s finances and lead to medical bankruptcy at worst, or stressful financial unwellness that is an unwelcome side effect of being very sick in America. For more on financial toxicity, see my post, Financial Toxicity: The High Cost of Cancer Drugs in the U.S. […] said : Guest Report 2 years ago

[…] that offers several products in the oncology space. Part of my discussion with the team was on “financial toxicity” — that is, the side effect of specialty oncology drugs that is high costs and financial […] said : Guest Report 3 years ago

[…] Health Populi’s Hot Points:  The status quo LaFountain points to (e.g., outmoded claims-based business models) can nudge people in the wrong direction. In my health economics world, I would point to the adverse impacts of high-deductible health plans, nudging some people to postpone necessary care, or not filling and taking a prescription as instructed. Our colleagues at Sloane-Kettering have termed this “financial toxicity,” another side-effect beyond clinical toxicity, discussed here in Health Populi. […]

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