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ASCO to help cancer docs evaluate treatment value

The American Society of Clinical Oncology's algorithm to help oncologists evaluate the clinical benefits, side effects and costs of a cancer drug or therapy will be fine-tuned over the summer and should be available for public comment by the fall, said Dr. Lowell Schnipper, chair of the society's Value in Cancer Care Task Force.

That was one piece of a larger discussion at ASCO's annual meeting about what needs to be done to get soaring cancer care costs under control. Assessing the value of cancer therapies was a major topic, with sessions looking at issues like whether or not patients are getting what they pay for, the ethical obligations faced by physicians and what if anything can be done to help drive down the costs. Although there have been important advances in cancer therapies over the past few decades, drugmakers are more frequently creating “me-too” drugs—generic versions of previous innovations which often sell at higher prices.

The ASCO task force started meeting with consultants and other value experts earlier this year to begin developing the cost-comparison tool, in response to growing concerns over the rise in new, more expensive cancer drugs that provide only incremental benefits for patients.

“We want innovation,” Schnipper said at the meeting. “But at the same time, we don't want our patients and their families to go bankrupt for a treatment that only offers a few additional months of life.”

Annual global spending on cancer drugs is approaching $100 billion, and the average cost per month for a brand-name oncology drug is approximately $10,000, nearly double from what it was a decade ago, according to recent estimates from the IMS Institute for Healthcare Informatics.

For example, one melanoma treatment costs upward of $120,000, three doses of a prostate cancer medication have an estimated $90,000 price tag and a lifelong treatment for chronic myeloid leukemia averages around $70,000, according to an analysis in the journal Mayo Clinic Proceedings.

Experts say more needs to be done—by physicians, pharmaceutical companies and government—to fix what one economist called “the perverted prices” of cancer drugs.

“We have an obligation to improve the system,” said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, who attended this year's conference. “There's no way the current system is going to sustain the costs,” he said. The rapidity of the rise in costs and the projected impact on U.S. health spending will get the attention of policymakers, he predicted.

During a session at the conference, Rena Conti, assistant professor of health policy and economics at the University of Chicago, presented new research looking at what determines the price for new cancer drugs. She and colleagues found the single largest predictor of a new drug's price is how a similar drug was priced the previous year. “Benefit matters,” Conti said. “But we're seeing launch price inflation, even in relatively crowded therapeutic classes.”

Conti said adjustment to physician payment policies would help. “Physicians have a financial incentive to use really high-cost cancer drugs even when the potential benefit for the patient may not be much more,” she said. Their practice revenue is based on the difference between the price they pay for a drug and how much insurers will reimburse them.

Hospitals also face perverse incentives. Schnipper said hospitals get paid for how many patients they admit, how many procedures they do and how much chemotherapy they give. “That is not a prescription for cost control,” he said. “We all know that something has to change.”

Follow Sabriya Rice on Twitter: @MHSRice

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