A new tool will allow oncologists to compare various drug treatments for four common cancers based on survival, side effects and costs. The American Society of Clinical Oncology released the framework Monday as part of a broader effort to help physicians and patients choose appropriate therapies amid the skyrocketing costs of cancer drugs.
“It's no longer enough to just know how different treatments compare on clinical outcomes. Patients also need to understand what it's going to cost to achieve those outcomes,” said Dr. Richard Schilsky, ASCO's chief medical officer. “They confront these decisions right now without the benefit of an explicit way of looking at the information. That's what we're trying to provide.”
The topic of cancer drug costs was prevalent during sessions at ASCO's annual conference this month in Chicago. Several presenters urged tougher approaches to rein in costs. Seven of the most expensive drugs covered by Medicare in 2013 were cancer medications, according to a report published during the conference. New CMS data released around the same time showed that significant portions of Medicare Part B payments to oncologists go toward the drugs administered in their offices.
Physicians have had a financial incentive to choose higher-cost treatment. Medicare pays practices the average sales price of physician-administered drugs plus 6%. As a result, they may opt for the higher price drug, even when the potential benefit is equivalent to a less expensive therapy.
The move to value-based payment models is bringing the discrepancies in prices to the forefront.
The “financial toxicity” of some drugs, meanwhile, has even led patients to extremes, such as taking out second mortgages, declaring bankruptcy and skipping needed treatments and tests, Schilsky said.
The new framework, published in the Journal of Clinical Oncology, is meant to make the benefit and costs more transparent. It provides four drug comparisons for the first-line treatment of metastatic non-small cell lung cancer; one drug comparison for the treatment of advanced multiple myeloma; two placebo and one drug-to-drug comparison for the treatment of advanced prostate cancer; and two drug comparisons for the second-line treatment of HER2 positive breast cancer.
For example, two combination therapies for metastatic non-small cell lung cancer had no differences in clinical benefit or toxicity, but it cost nearly $8,400 more for physicians to acquire the newer therapy. A treatment combo for HER2 positive breast cancer that cost $65,700 for oncologists to acquire reduced the risk of death by 23%, providing a higher net health benefit than its $7,052 competitor. ASCO plans to add additional comparisons in coming years.
The price tags illustrate how much oncologists pay to acquire the drug therapies because the price patients ultimately pay can vary depending on their individual need and insurance. However, one can generally understand that if a patient has a 20% co-pay on a drug that costs $10,000 per month for the clinician to obtain, it may cost a patient $2000 a month out of pocket, Schilsky said.
Still, the question remains as to whether or not the prices being set for new drugs are fair in the first place. Some researchers are urging more focus on creating formulas to help establish costs for new drugs and define the value of a new regimen before the treatment reaches market. Others say use of new diagnostic tools should help produce faster trial findings, using fewer subjects, and result in lower research and development costs.
University of Chicago researchers concluded in a recent study that the single largest predictor of launch prices for cancer drugs are the prices from previous years, resulting in launch-price inflation, even in relatively crowded therapeutic classes.
“It boils down to the nuances of how you define high value,” said Schilsky. That definition, he says, was one of the biggest points of contention in developing the comparison framework, written by a 24-member multi-stakeholder group, including oncology and patient groups, health insurers and pharmaceutical representatives.