Oncologists Worry About Rising Costs of Cancer Treatment

Prescription drug spending increased sharply last year, and cancer drugs were responsible for a huge chunk of that jump. Out of the nearly $374 billion Americans spent on prescriptions in 2014, $32.6 billion -- about 9 percent -- was spent on oncology drugs, according to the annual report by IMS Health Informatics. Another $11.1 billion was spent on supportive care treatments, which help with the side effects of strong chemotherapy drugs.

But cancer drugs were not the most widely prescribed by a long shot. Even though oncology medications made the most money of any other drug class on the IMS report's list, not one oncology medication cracks the 20 most widely prescribed. Cancer drugs are just extremely expensive.

The expense of those drugs is not lost on cancer doctors, who say cost is restricting access for too many patients. So, a group of doctors on a mission to increase patient access to cancer therapies has rallied to do something about it. The American Society of Clinical Oncology, which includes 35,000 cancer professionals, has assigned a task force to help patients assess the value of their drug options.

Costs of Cancer

Newly approved cancer drugs cost an average of $10,000 per month, with some therapies topping $30,000 per month, according to ASCO, which discussed the costs of cancer care at a recent meeting. Just a decade ago, the average cost per month of new drugs was about $4,500. Patients typically pay 20 to 30 percent out of pocket for drugs, so an average year's worth of new drugs would cost $24,000 to $36,000 in addition to health insurance premiums.

Drugs aren't the only expense. Patients must also pay for drugs that mitigate the side effects of chemotherapy, pay provider and facility fees and often lose income when they miss work or lose their jobs.

Those provider and facility fees are no joke. According to UnitedHealthcare data, drugs themselves account for only 24 percent of direct cancer costs. Hospital and outpatient facilities account for 54 percent of costs, and physician fees account for 22 percent.

"There are many direct and indirect costs of cancer, and that is an unimpeachable fact," Dr. Lowell Schnipper, chairman of the ASCO Value in Cancer Care Task Force, said during a news conference on June 22.

Value in Question

Cancer drug costs fluctuate all the time, increasing and decreasing whenever the manufacturer sees fit to change the price. Take Novartis' leukemia drug Gleevec, which cost $24,000 in 2001 when it was approved as a breakthrough drug; now it costs $90,000, according to Forbes. Unfortunately for patients, the cost has little to do with efficacy of the drug or its safety.

For example, a recent clinical trial looked at the safety, efficacy and price of two treatment regimens for metastatic colorectal cancer. Both treatment arms included a standard chemotherapy in addition to one of two antibody drugs known to improve the chemo drug's outcome.

The study, which included more than 2,300 participants, found no difference in outcome between the two antibodies; survival rates and disease progression were about the same. However, one cost about twice as much as the other: $9,300 versus $20,100 for an eight-week cycle. Over the course of the study, patients received no clear benefit by taking the expensive antibody, but their treatment cost $39,000 more, on average.

Possible Solution

If cancer drugs were priced based on how well they work or how many side effects they have, navigating the cost of a course of treatment would be easier. Because that option won't be available any time soon, ASCO has proposed a framework for determining how good a drug is for its price.

For any given cancer drug included in its analysis, "the framework would enable a patient to more or less compute the net health benefit," Schnipper says. Although the framework uses a scoring system, Schnipper says ASCO never set out develop a scale or ranking system, but rather a tool "for facilitating a discussion about costs between doctor and patient."

Using clinical trial data, the framework assigns points based on the rates of overall survival or progression-free survival of two or more drugs for comparison. If those are not available in trial data, then the response rate to treatment, or proportion of patients with reduced tumors, is used to get the net benefit score. Toxicity relative to other treatments can make the score go up or down 20 points on a 100-point scale.

Finally, for advanced or metastatic disease only, bonus points are added when a treatment provides objective improvements in quality of life. Those include prolonged intervals where no treatment is necessary, or a treatment that alleviates serious symptoms, according to Schnipper.

The overall score of each treatment is intended to be evaluated alongside price, to encourage a discussion between doctor and patient about the value of each treatment.

"Patients want to talk to their doctors about cost issues," Dr. Richard Schilsky, ASCO's chief medical officer, said in the same news conference. This is especially true for cancer patients, he said, who are 2.5 times more likely to file for bankruptcy than people who don't have cancer.

Next Steps

The ASCO task force is now taking public comment until Aug. 21 at its Value in Cancer Care page. They're soliciting feedback in hopes of improving the framework and launching a tool that patients and doctors would use together to better inform treatment choices.

Until that tool is available widely, ASCO encourages patients and oncologists alike to start a discussion about costs of treatment. For patients and caregivers currently struggling with cancer costs, cancer.net has a list of helpful questions to ask your doctor, along with financial resources.