The cost of cancer care in the United States is a critical subject for many Americans and a topic of debate within governmental, academic, and industry groups. The September 2009 issue of the
Journal of Oncology Practice (JOP) focused on the cost of cancer care and provided important insight on the causes and potential solutions for the problem.
In the interview that follows, Michael N. Neuss, MD, Chair of the Clinical Practice Committee, discusses important factors surrounding the cost of cancer care.
AN&F: How is the cost of cancer care different than the costs of care for other major diseases?
Dr. Neuss: As is noted in the American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care, drug costs are generally a greater proportion of the total cost burden for patients with cancer than for patients with other diseases. Additionally, the benefits of using those drugs are not seen in every patient; in order to help a small number of patients realize benefit from these drugs, we must treat a larger number of patients.
We all wear our seat belts, hoping, of course, that we won’t need them, and also that they won't somehow cause a greater problem to us in some unusual circumstance. Patients with colon cancer who receive adjuvant therapy individually may experience no benefit because they happen to do well even without treatment (like people who wear their seatbelts and don't have an accident). Alternatively, in a sadder circumstance, they might also suffer a recurrence no matter what treatments they receive. And a few may actually suffer greatly from taking the drugs.
In the end, a treatment that may include more than $50,000 in drug costs may be given to 100 patients and only help 20 of them. Even in a circumstance where a drug may help a greater proportion of patients, for example the use of imatinib in chronic myelogenous leukemia, the daily drug costs of $130 may be too much for patients to bear. Clearly, there is a tipping point at which the drug, no matter how good it is, is unaffordable to individuals and society. Imagine a drug that caused metastatic breast cancer to go into a complete remission, but that had to be taken every day to maintain the remission. Would that circumstance be reasonable if it was priced at $1,000 per day? What about $5,000?
AN&F: What cost issues need the most immediate attention or resolution?
Dr. Neuss: As a political issue, out-of-pocket expenses get more attention as individuals experience the problem. This is glaringly obvious in the Medicare Part D “doughnut hole.” However, as a societal issue, total cost is probably more important. A better understanding of who benefits from expensive treatments would go a long way toward helping us expend resources more wisely, and basic research is clearly going to be helpful in this area.
AN&F: What needs to happen first to make progress?
Dr. Neuss: Research will help a lot in approaching these issues. If we can remove any questions of whether a particular treatment really helps an individual—as opposed to a population of people in similar circumstances—we can more easily understand and discuss the costs and benefits of an intervention.
AN&F: Are there any ideal solutions?
Dr. Neuss: It is best to intervene only with a clear understanding of the benefit. Targeted therapies designed to approach a specific identified molecular characteristic represent the most effective but also the most expensive treatments available. If we had a drug that could be guaranteed to “cure” 90% of the patients who took it, but they had to take it every day in order to keep their otherwise fatal cancer in remission, what would it be worth? The definition of circumstances to increase the likelihood of benefit to our patients makes it easier to understand the benefits relative to cost.
AN&F: What role does ASCO play in finding a solution to this problem?
Dr. Neuss: AS CO is a powerful public voice in educating doctors, patients, and other interested parties, including the public at large and legislators. Promoting basic and clinical research, providing many educational opportunities, and keeping the discussion fact-based are all factors in AS CO's approach, which is exhibited in the guidance statement and everything the Society does.
Read the full text of the September issue online at
jop.ascopubs.org.
