The Cost of Cancer Drugs
Everyone is aware of the escalating concerns about the cost of health care in the US. Drugs in general, and cancer drugs in specific, are one of the factors related to this growing crisis. I suspect that almost everyone agrees that we have a system that cannot continue indefinitely without some changes. I also suspect that shared beliefs quickly collide when we try to be more detailed about costs. "Value" is the word most often being used in conversation. What is the "value" of any particular treatment? Should there be criteria that are applied to all possibilities? Is it more of a case by case decision? And who gets to make the decision?
I was at a dinner on Friday night, a gala to recognize the work of a well-respected oncologist, and had this conversation with a number of other guests. There was shared worry about the problem and many different opinions about the best way to proceed. One woman has just written an article about "value" and had lots to say about different perspectives and the near impossibility of consensus. It seems to me that the patient needs to be included in any conversation about "value", and I think that most of us could identify what is most personally valuable. Our own goals are likely not identical, and we may each have shifting ideas about what is most important in the delicate balance of quality vs. quantity of life, including cost. Is an additional month of life, likely with side effects, worth $10,000? $100,000? A second mortgage on the family home?
This is a thoughtful piece from Medpage about the high costs of cancer drugs. Here is the start and a link to read more:
Sky's the Limit for US Cancer Drug Prices, Says Top Doc
There is no price that is too high for cancer drugs in the United States because Americans just can't say no, says Leonard Saltz, MD, from Memorial Sloan Kettering Cancer Center in New York City, in an editorial published online February 17 in the Journal of Clinical Oncology.
Dr Saltz phrased it this way: "There is virtually no level above which we have been willing as a society to say, no, it does not make sense to spend that much money for that little benefit, and therefore we won't do it."
Furthermore, he says that drugs — and cancer drugs in particular — are "unlike virtually all other goods and services" because they are "above discussion of, and indeed even consideration of, cost."
Dr Saltz's comments accompany a study of the cost-effectiveness of adding bevacizumab (Avastin, Roche/Genentech) to chemotherapy for the treatment of metastatic colorectal cancer in the United States, conducted by Daniel Goldstein, MD, from the Winship Cancer Institute of Emory University in Atlanta, and collaegues