Oncologists Consider Value: About Time!

I suppose coming late to the table, albeit at a great cost to society, is better than missing out completely.  That’s the way I read the recent earth shaking announcement by ASCO (American Society of Clinical Oncology) of a “value framework” for considering cost in the evaluation of a drug.

Drug costs have increased such that new medications for cancer are in the $100,000/year and higher range.  It is  not so surprising  that  doctors buffered by insurers, isolated from the billing procedures and in many instances on the payroll of drug companies have been slow to discover that their patients endure hardships in trying to pay for medications and that drug costs seem disconnected from efficacy.

He said the price of new cancer drugs now averaged about $10,000 a month, and some cost $30,000 a month, which can mean prohibitive co-payments even for some patients with good insurance. “Many cancer patients are facing severe financial strain, even bankruptcy in some cases,” he said.

The value framework envisions considering two costs: the out-of-pocket costs for the patient and the overall cost of a drug to the health system.

Drug companies of course don’t like the idea saying that drug costs are only part of the total cost of care (all of which has inflated in recent years)

But most telling:

Some experts say that ideally, the price of a drug should reflect its value, but that does not seem to be the case with cancer drugs. A recent study by researchers from the National Cancer Institute, published in JAMA Oncology, surveyed cancer drugs approved from 2009 through 2013. It found that prices did not correlate very well with how novel a drug was or whether it prolonged life versus just shrinking tumors.

Medicynical Note:  As I have noted previously our health care non-system is not designed to provide efficient cost effective care but rather to provide revenue to patent holders, insurers and the various providers.  There are no brakes in the system on costs.  The FDA is prohibited by congress (influenced by drug lobbyists) from evaluating cost-efficiency of new products; Medicare is prohibited by congress (influenced by drug lobbyists) from negotiating price or even evaluating value.  And doctors for whatever reason felt it unethical to consider costs when choosing an intervention.   It’s a perfect system for revenue generation but a rolling disaster for patients and society who ultimately have to pay the bills.  It’s bankrupting us.

We lead the world in costs, individual bankruptcy from health care expenditures (unknown in other industrialized countries) and the number of people without health care insurance.  This is not a desirable or viable health care system.

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