Budget Impact Concerns Volume, Not Value: Prevention Is Key to Winning the War on Cancer

Jessica Miller

November 2016, Vol 7, No 10 - Value in Oncology


Boston, MA—Are we winning the war on cancer? According to Joshua J. Ofman, MD, MSHS, Senior Vice President, Global Value, Access and Policy, Amgen, the answer is yes. Dr Ofman discussed the economics of cancer, including challenges facing insurance providers and ways to impact the rising cost of cancer care, at the War on Cancer forum hosted by The Economist.

“Everyone is viewing this challenge from a very narrow silo, and we need to take a step back and look at this more holistically,” he said.

“The death rate for cancer has dropped well over 22% in the last 2 decades. If you begin to think about the 14 million estimated patients in the United States by the CDC [Centers for Disease Control and Prevention]…and the almost 4 years of extra life they’ve been afforded over the last 2 decades, it’s about 54 million life years that have been gained in this country. And if you just conservatively value those years of life, you get almost $5 trillion in economic value,” Dr Ofman said.

The return on investment in cancer care is unequivocal, Dr Ofman said, noting that all too often, people look at spending without looking at the outcomes.

“When thinking about the costs of cancer and the cost of cancer drugs it has to be put into that context,” he said.

According to Dr Ofman, the right conversation about value is not necessarily happening.

“The conversation that we’re having is about how to put budget caps on biopharmaceuticals. We have to remember that budget impact, while very important and impactful, and we need to talk about that, has absolutely nothing to do with value. Budget impact is about volume, not about value, which is exactly the opposite of where we’re trying to go to in healthcare, which is to a system that rewards value, not a system that rewards volume,” he explained.

The right conversations should focus on how to stop paying for things that do not work, and how to make sure that patients have unrestricted access to things that do work, Dr Ofman said.

Prioritizing Prevention Strategies

One such thing that Ernest Hawk, MD, MPH, Vice President, Cancer Prevention and Population Sciences, M.D. Anderson Cancer Center, Houston, would like to see patients have more access to is cancer prevention programs. In addition to cancer screenings, such as colonoscopy and mammography, prevention programs also include lifestyle changes, such as avoiding tobacco, being physically active, eating properly, and limiting exposure to excessive and artificial ultraviolet radiation.

“When we talk about the economics of cancer, it would be irresponsible to concentrate only on therapy and ignore these things that we know have a very broad and significant impact…not only on reducing cancer, of course, but on promoting a healthy life,” Dr Hawk said.

Although some experts on the panel questioned whether prevention was the way forward in cancer care, Dr Hawk argued that it had a place in the conversation, noting that—based on recent academic estimates—“a third to a half of the cancers that occur in the American population are indeed preventable.”

Cancer control plans have the potential to be extremely beneficial when evidence-based practice is introduced at the population level, he told listeners. In fact, many countries across the globe have been introducing prevention plans, yet America does not have one.

“We have 51 individual state and district plans, but we haven’t come together to really prioritize prevention. It has not gone nearly far enough in advancing the conversation around the importance of these strategies at the population level, to say nothing of those that could be implemented in the clinic for certain individuals,” Dr Hawk said.

How Insurance Coverage Factors into Prevention

Roy Beveridge, MD, Chief Medical Officer, Humana, Louisville, KY, agreed about the important role of cancer screenings, but the current US health insurance system does not promote implementation of screenings on a large scale.

“The problem in our system in the commercial world…is there’s a big turnover of the population every 2.5 years. And so you have a lack of alignment of incentives,” he said. One payer may pay for all appropriate screening tests for a person, but if after 2.5 years that person leaves and no other payer is paying for all screening tests, that’s a drawback for the first payer.

“You may be doing the right thing, but you’re at a disadvantage, which is why there needs to be standardization for all of these processes if we’re going to continue to have this churn within the commercial side,” Dr Beveridge pointed out.

This, however, is not an issue with Medicare Advantage plans, because the majority of the population in these plans stays with the same insurer for ≥8 years, which provides “a great incentive both from a medical oncology standpoint, as well as from a financial one, to optimally prevent cancer in our population once we see them,” Dr Beveridge said.