Cancer Drug Costs Do Not Always Align with Value
Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology, Social Work
JUNE 16, 2020
For people with good medical insurance, most treatment costs are covered, and patients often don't know how much individual cancer drugs cost. As drug prices climb and insurance coverage becomes more limited, more of us are being impacted by costs. Almost all, and I am tempted to say all, medical insurance policies now require hefty deductibles and co-pays and set caps on their coverage. Many insurance companies have a list of drugs that they will cover, and that list may not include the newest cancer treatment that your doctor has recommended.
Each new drug seems more expensive than the last, and it seems there is no ceiling. A recent study published in Lancet Oncology examined 65 cancer drugs that have come on the market over the past decade and found no association between their cost and their clinical value to patients. "Prices of cancer drugs should be better aligned with their clinical benefit to improve access to beneficial medicines and enable limited resources to be used for treatments that offer patients improved outcomes," said lead author Kerstin Noëlle Vokinger, MD, JD, PhD, LLM, assistant professor for public law and digitalization, health law, and regulatory sciences at the University of Zurich, Switzerland.
I find this infuriating, horrifying, and morally unjustifiable. It also puts cancer patients and oncologists in a very difficult and tricky situation. Patients depend upon their doctors' recommendations and have no way of knowing the detailed studies and possible value of new drugs.
If, for example, you are living with Stage IV colon cancer and have already received the standard drugs, and if they have run their course of being useful, you are likely going to jump at the possibility of something new. Your doctor probably won't have a great deal of information about newly approved cancer drugs, because they just have not had a long enough track record to accumulate that data. We trust the clinical trials process and assume that the FDA is only approving drugs that have shown a benefit in these trials. A catch, however, is that we really don't know how much of a benefit they will have to larger numbers of people.
In cancer research, a new drug may be considered successful if it extends life by a few weeks. For some, every day of life may be worth any cost, but other people feel differently. If the new drug carries a co-pay of thousands of dollars (and some do), brings unpleasant side effects and turns out to be of little or even no value, we would want to know about that possibility before making a choice.
There are value frameworks that have been thoughtfully developed by professional groups in the United States and in Europe, but they don't always link the value of a drug to its cost. The American Society of Clinical Oncology (ASCO) and the European Society of Clinical Oncology (ESPO) have released guidelines that address this issue.
In the United States, where drug prices are the highest in the world, this is a problem that must be addressed, understood, and eventually managed. In the meantime, the onus is on us, the patients, to ask our doctors about the expected benefit from a new cancer therapy. We need to push a bit for information, and our doctors need to be fully forthcoming and clear about both the anticipated possible benefit and the toxicity, financial and physically.
Have you ever talked with your doctor about the cost of a cancer treatment and the likely benefit? Join the BIDMC Cancer Community and share your story.