AVBCC First Stakeholder Integration Conference
In 2011 we find ourselves in the midst of a “perfect storm” as it relates to cancer care in the United States. More people are being diagnosed with cancer, more patients are living longer with cancer, and the cost of caring for cancer is rising dramatically.
The Perfect Storm
Rising cancer cases. According to the American Cancer Society, in 2010 >1.5 million new cases of cancer (excluding carcinoma in situ and basalcell skin cancers) and nearly 570,000 deaths occurred from cancer.1 Cancer is responsible for 1 in 4 deaths in the United States and is the leading cause of death for individuals age <85 years. The sheer number of cancer cases in the United States represents the first arm of the perfect storm.
Rising cancer costs. Advances in our understanding of the molecular and genetic mechanisms of tumor growth are expanding the treatment horizons, but these ad vances come at a rising cost, and this cost represents the second arm of the perfect storm. In a June 2011 article published in the New York Times, the author notes that the cost of treating metastatic castrationresistant prostate cancer has increased dramatically in the past year. In the past 15 months, 3 new drugs that extended the lives of patients with prostate cancer in clinical trials have been approved by the US Food and Drug Administration, and several other promising medicines are in clinical trials. However, “the price of these drugs has already stirred concerns about the costs of care among patients, providers, and insurers.”2
With many pricey drugs in the pipeline, said Joel Sendek, an analyst at Lazard, “We could be talking easily $500,000 per patient or more over the course of therapy, which I don’t think the system can afford, especially since 80% of the patients are on Medicare.”2
This concern is not unique to this author. In a 2009 article, Peter Bach noted that in 1994, only 1 cancer drug— paclitaxel—cost >$2500 per month.3 As in the case of prostate cancer, new cancer drugs now routinely cost many times more. Mr Bach further notes that policymakers at the Centers for Medicare & Medicaid Services must be concerned about how to pay for these new and expensive treatments without bankrupting the system.3
Aging population. In a January 2011 article published in the Journal of the National Cancer Institute, the authors estimated that the total cost of cancer care in the United States would be $158 billion by 2020, assuming that the most recent trends of incidence, survival, and cost remain the same.4 This estimate represents a 27% increase from 2010, reflecting only the projected aging and growth of the US population. This demographic change is yet the third aspect of cancer’s perfect storm.4
AVBCC Conference Accomplishments
These statistics highlight only a few of the issues that provided the backdrop for the First Conference of the Association for Value-Based Cancer Care, which convened on March 29-30, 2011, in Philadelphia. The meeting was among the first of its kind to provide a forum for the multiple stakeholders involved in all aspects of cancer care.
The goal was to foster an open dialogue between providers, payers, patients, and other members of the oncology team to gain a better understanding of the issues regarding cost, quality, and access in cancer care. The participants had the opportunity to:
- Identify challenges and potential solutions regarding access to affordable oncology therapies
- Determine the value proposition of cost, quality, and access when evaluating the over all management of patients with cancer
Define appropriate clinical path ways to be used as tools to evaluate the cur rent recommendations for patient management Analyze trends in the delivery of care for patients with cancer.
Some of the many timely topics presented in this issue are:
- Community Oncology Clinics under Increasing Financial Pressure • Payer Trends in Oncology: Challenges and Solutions
- Value-Based Insurance Design in Oncology
- The Role of Molecular Diagnostics in Cancer Treatment.
These proceedings represent a firstin- class effort to open the lines of communication among all stakeholders in cancer care. This meeting was unique in bringing together different viewpoints from many oncology stakeholders, such as health plans, pharmacy benefit managers, providers, patients, government, manufacturers, and caregivers. Ultimately, the conference enabled stakeholders to share their own views of the world of oncology care and gain an understanding of the views of other stakeholders who also have a part in cancer care.
Opening the lines of communication among stakeholders with differing viewpoints in oncology was a major accomplishment of the conference. This allowed for sharing of issues that are critical to facilitating the best care possible for patients with cancer. Ultimately, all stakeholders shared the common goal of finding solutions to the growing concerns in cancer care, while understanding the need to optimize the clinical and economic value of the resources expended.
- Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277-300.
- Pollack A. New drugs fight prostate cancer, but at high cost. New York Times. June 28, 2011. www.nytimes. com/2011/06/28/health/28prostate.html?_r=2&hp. Accessed June 28, 2011.
- Bach PB. Limitations on Medicare’s ability to control rising spending on cancer drugs. N Engl J Med. 2009;360:626-633.
- Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117-128.