At ASCO 2011 there were very few studies on cost efficacy, it doesn’t seem to be an issue to researchers funded mainly by pharmaceutical manufacturers. There was however an interesting abstract (6004) which looks at the care provided and outcomes of patients in different socioeconomic groups.
The study was of patients with cancers of the lung, esophagus and pancreas which “account for over 35% of all cancer deaths in the US and a sizable share of cancer costs.”
The researchers from the University of Michigan used the SEER-Medicare data base and examined the effect of socio-economic status on treatment and 2 year survival rates. The authors found:
The lowest SES (socio-economic status) patients were more likely to require urgent or emergent admissions and to be treated at very low volume hospitals and non-teaching hospitals. For all three cancer types, low SES patients were more likely to receive no cancer-directed treatment (e.g., 60% of the lowest SES patients received no treatment for pancreas cancer). Receipt of cancer-directed surgery, chemotherapy, and/or radiation therapy was consistently higher for the highest SES patients, with most patients receiving at one type of treatment and many receiving a combination of treatments.
There is pronounced variation in types of cancer treatment received by different SES groups. Despite receiving more aggressive treatments, higher SES patients do not have improved survival rates.* Reducing variation in treatment strategies may improve healthcare efficiency without changing patient outcomes.
*emphasis by medicynic
Medicynical Note: I’m not sure what more there is to say. We have a primeval, possibly money driven urge, to do all modalities of treatment to patients with bad disease, especially to those with money, insurance or other resources. But we have no impact on the ultimate course of the disease.
This mania is costly. We are using drugs and procedures costing our health care non-system many thousands of dollars a month, uselessly. More careful shepherding of resources and more considered use of treatments would save money (lots) and not impact outcomes adversely.