Cancer Care in 2013: Hope, Reality, and a Call to Action

August 2013 Vol 6, No 6 Special Issue - Payers' Perspectives
Gary M. Owens, MD

The cost of cancer care is an issue of major importance to payers in 2013. There are more than 12.5 million people living with cancer in the United States today, and that number is rising.1 According to a recent study published in the Journal of the National Cancer Institute and supported by the National Institutes of Health, “Based on growth and aging of the U.S. population, medical expenditures for cancer in the year 2020 are projected to reach at least $158 billion (in 2010 dollars)—an increase of 27 percent over 2010,”2,3 the authors pro-ject. The authors go on to state that
if newly developed tools for cancer diagnosis, treatment, and follow-up continue to be more expensive, medical expenditures for cancer could reach as high as $207 billion by 2020, which represents a growth of 67% over 2010 costs, and is, by all accounts, considered unsustainable.2

Payers are of course concerned about the rising costs of care for patients with cancer, but it is not only payers who are concerned about these cost trends. In a recent article published in Blood, 100 leukemia experts concluded, “Pricing of cancer and other drugs involves complex societal and political issues which demand immediate attention, and which will need to consider many factors and involve many constituencies….We propose to begin the dialogue by organizing regular meetings, involving all parties concerned, to address the reasons behind high cancer drug prices and offer solutions to reduce them.”4

Impressive Drug Developments
This special issue is focused on cancer care and highlights critical issues presented at the 2013 ASCO annual meeting, including the cost of care, utilization trends, and new therapies for a variety of cancers. The number of novel therapies currently in the pipeline for the treatment of cancer is impressive, as described in the article summarizing key drugs in late-stage development or those in early development that have shown promising results or chart new directions in drug therapy.

For example, there is a new MEK inhibitor being developed for melanoma that shows great promise for the treatment of metastatic ocular melanoma—a difficult-to-treat cancer. We further learn about a new class of immunotherapeutic agents that block the programmed death (PD)-1 and its ligand (PD-L1) that facilitate T-cell tumor destruction. We also learn about novel developments for the treatment of various hematologic malignancies, including lymphoma, leukemia, and multiple myeloma. Similarly, there are exciting new compounds that are in development for the treatment of solid organ tumors, including lung and ovarian cancers.

Inefficient System of Care Delivery  
However, these exciting developments that promise hope and improved outcomes for many patients with cancer are being contrasted with the stark reality that our system of cancer care delivery is in need of significant change. For example, data presented from a study by eviti show that more than 25% of patients included in that study had treatment plans that did not conform to evidence-based cancer care. In addition, inappropriate deviations from the standards of care for cancer cost more than $25,000 per patient, based on that study. Clearly, these types of treatment patterns cannot be ignored. The presenter concluded that, “Decision support tools that are used at the point of care can help avoid overspending.”

Furthermore, an evaluation of the Surveillance, Epidemiology and End Results (SEER)-Medicare database revealed that 18% of the spending on cancer drugs is for off-label use, meaning that many drugs prescribed for patients with cancer are used off-label and are also not endorsed by the National Comprehensive Cancer Network compendia for that purpose.

In yet another article we find out the use of costly diagnostic imaging of uncertain value is increasing rapidly for patients with localized, non–small-cell lung cancer, according to data from the SEER-Medicare database. Kevin A. Schulman, MD, MBA, commented that, “If we really want to make progress in an economically viable way, we must spend as much time on the economics of drug development as on the basic science.”

Cancer affects approximately 3% to 4% of a health plan’s population, yet the current cost of caring for those patients exceeds 10% of total medical costs, and those costs are growing rapidly. Recent and ongoing developments in cancer care show promise to improve outcomes and quality of life; in many cases, cancer is becoming a chronic illness, joining diabetes and heart disease as one of the top drivers of medical costs in the US healthcare system.

The articles in this special issue highlight these contrasts. We learn about many new developments and advances in therapy, but those advances are contrasted by many reports of inefficiencies in the system that will need to be addressed to temper the current cost trend that is associated with caring for the growing number of patients with cancer at all stages—from diagnosis to survivorship and end-of-life care.

A Call to Action
Therefore, all stakeholders—including payers, providers, drug developers, employers, and patients—will need to join together to embark on a meaningful dialogue about these issues, including the proper use of guidelines and pathways, improving delivery systems and reducing waste, and adhering to therapy. It is essential that all stakeholders begin to work collaboratively to develop and promote new systems of care, new models of drug development, and new payment methodologies for oncology. Without such initiatives, the burden of cancer care will continue to grow at an unsustainable rate and access to cancer care will remain a serious concern.

References

  1. American Cancer Society. Cancer prevalence: how many people have cancer? Revised October 23, 2012. www.cancer.org/cancer/cancerbasics/cancer-prevalence. Accessed August 8, 2013.
  2. Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117-128.
  3. NIH News. Cancer costs projected to reach at least $158 billion in 2020. January 12, 2011. www.nih.gov/news/health/jan2011/nci-12.htm. Accessed August 8, 2013.
  4. Experts in Chronic Myeloid Leukemia. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood. 2013;121:4439-4442.
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