How Will We Pay for Cancer Treatment?
?With the fanfare of a New York Times Op-Ed piece by Peter B. Bach, MD, and colleagues, the announcement was made that Memorial Sloan-Kettering Cancer Center (MSKCC) would exclude the new colorectal cancer drug ziv-aflibercept (Zaltrap) from its formulary. Regardless of questions raised about the accuracy of the cost and the dosing comparisons and certain conflicts, the question is—Will the MSKCC decision influence community oncology clinics to consider a similar restriction?
Although the press around the MSKCC decision has caught the attention of community oncologists, I believe that they will not be unduly influenced by it. In this day and age, oncology clinics typically are basing treatment decisions on evidence-based guidelines that are evolving into specific treatment pathways. These pathways incorporate national information on efficacy and cost, as well as the experiences of oncologists and practices.
The realities of the increasing cost of cancer treatment have been on the radar screens of community oncologists for several years, as well as the effort required to ensure that all patients—including Medicare recipients and those with private insurance—have access to the optimal standard-of-care treatment. So, most oncologists will weigh the facts and will make decisions in concert with their patients.
From a societal standpoint, the MSKCC decision begs the larger question of how we will pay for the rapidly escalating cost of cancer treatment and who the arbiter is.
Some would like to see a UK-type National Institute for Clinical Excellence–like board decide at a governmental level what cancer drugs get paid for, based on the calculated value- of-life extension from a specific medication. Others fear that our government regulatory and payment agencies are already moving in that direction, without legislative mandate.
Some, presumably like MSKCC, believe that the institution must intervene, as in the case of ziv-aflibercept. Yet others believe that individual physicians, who are familiar with specific efficacy and cost data, must make decisions in concert with their patients. My guess is that most physicians agree that the rapidly escalating cost of cancer treatment is unsustainable, and that something must be done, starting with the drug manufacturers.
From a policy perspective, I believe that we first need to substantially trim the regulations, inefficiencies, and costs that impede bringing effective, safe new cancer drugs to market, as well as ensure accessibility to low-cost generics, which are increasingly in short supply.
Competition will produce the best treatments with the optimal value propositions. Manufacturers with superior science and understanding of market needs will prosper.
Oncologists will be able to focus on getting the optimal treatment to patients, based on the value equation—and patients with cancer will end up the ultimate winners.
Until we fix an increasingly dysfunctional cancer care landscape, it is unclear how we will pay for cancer treatment going forward.