High Drug Costs a Factor in Cancer Care

The cost of cancer care is rising at the rate of approximately 15% annually, according to the American Society of Clinical Oncology. The main contributor? New drugs and related drug combinations that have improved outcomes and reduced side effects, but that have also brought the cost of cancer care to more than $72 billion in 2004. That, says Brent Clough, CEO of IntrinsiQ, a leading source for U.S. oncology data and analysis, is what makes cancer care so incredibly unique.

“It’s multitudes of shades of gray; there’s no magic bullet,” says Clough. “Just because you have lung cancer or breast cancer doesn’t mean you take drug A or drug B for a certain duration and then you’re done. Today, we’re seeing patients who may have four, five, or six different lines of therapy. Patients are living longer, and they’re taking shorter durations of targeted therapies that are addressing a very focused piece of the cancer. It’s incredibly complex.”

That complexity, adds Leon Cosler, PhD, associate professor, Albany College of Pharmacy and director of the college’s Research Institute of Health Outcomes, is what has “every major insurer, from the federal government to any private payer, struggling right now with trying to manage oncology care.”

Number crunching

Cosler explains that the use of cost effectiveness and cost-benefit studies is peaking in oncology right now because, “That’s the only economic tool at our disposal to help answer the question, are these additional costs worth it?” As an example, Cosler points to the drug docetaxel, which, when added to the treatment of metastatic breast cancer, adds approximately $2,400 for every additional month of life a patient receives. “Once you know that, then the onus falls on someone to decide, is it worth it?” Not an easy call.

An insurance company, says Cosler, can make a decision about what it will or won’t pay for, but ultimately, it’s the oncologists who are in charge of the therapy for their patients. Thomas Simmer, MD, senior vice president and chief medical officer for Blue Cross Blue Shield of Michigan, agrees. “The care of patients with cancer rests with the oncologists,” he says. “They are the ones who have to understand how their practices are performing.”

To that end, BCBSM recently began partnering with ASCO and approximately 180 oncologists in 11 physician groups across the state to improve care for cancer patients. The oncologists are submitting information—including chemotherapy planning, chemotherapy-related side effects, pain assessment and control, and specific measures related to the management of colon and rectal cancer, non-Hodgkin’s lymphoma and lung cancer—to a national database established by ASCO to help the physicians identify what works best in cancer care.

For example, one piece of information the oncologists will receive back is the percentage of their patients who receive chemotherapy within the last 2 weeks of life. “That’s an interesting piece of information that doesn’t tell an insurance company as much as it would tell each oncologist,” says Simmer.

He explains that oncologists from one academic medical center came in at 86 percent. It prompted them to ask themselves whether or not they were providing care that was really in the patients’ best interest just 2 weeks prior to death. “We provide [the oncologists] a forum by which they meet quarterly, and we encourage them to begin to take the initiative to improve the things they want to improve.”

Unique partnership

Cosler says the fact that BCBSM is partnering with oncologists in the state is rare, but also invaluable, because the doctors are the ones who must review the data and reach a consensus on treatment options. “It would be much more difficult [for an insurance company] to look at the data in a vacuum and say, ‘We’re not paying for X.’” In addition, ASCO’s registry contains pieces of data that an insurance claim would never have; information that is highly valuable in helping to tailor patient care.

“Many times a payer will make decisions without input from the provider community,” says Cosler. “The partnership is, in my opinion, a wise move and a strategic move because of the very important role of the oncologists.”

Giving oncologists access to the information in ASCO’s registry, says Simmer, is the main reason for the partnership. “Cancer care, by definition, involves a lot of care with significant potential to cause unwanted harm; it’s the nature of radiation therapy and chemotherapy,” he explains. “Whenever you have a situation where care can be beneficial or it can cause harm, it’s a major benefit having information that lets you know where you stand relative to treatment that minimizes the bad and maximizes the good.”

The partnership, adds Simmer, is a long-term proposition. “Cancer care is changing more rapidly than any other field. There will always be opportunities for us to use this information to refine how oncologists care for patients, and to frame their own efforts to improve that care.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at edwardr@frontiernet.net.