When the Cost Curve Bent — Pre-Recession Moderation in Health Care Spending

e18358 Background: Health care spending in US is highest in the developed world and contributes to up to 1/5 of the GDP. The price escalation is steep and contribution from cancer care is soaring. The cost of medications is deemed to be the leading cause of increased health care spending. In this era of precision medicine, with more effective and better tolerated drugs, patients are using them for longer periods of time, adding to the ever mounting health care spending. Methods: We used a large claims based data set US database MarketScan to explore the economic burden of drug cost in cancer care. Between January 1, 2013 and September 30, 2015 we identified 195,290 enrollees with active cancer. We analyzed the economic burden of medications for overall cancer care by exploring the total cost of care and the pharmacy expenditure by various classes of drugs for these patients. The perspective was that of the health care system as the costs included payments by the insurer and the patient. Results: There were 195,290 active cancer patients in this analysis. Mean age was 61 years, 55% were females. Breast cancer was the most common diagnosis. Mean total cost of care and total drug cost per patient over the study period was $141,415 and $13,579, respectively. The total pharmacy expenditure across all study patients was ~2.5B. Antineoplastic drugs make up the largest portion of the total pharmacy expenditure at 39%. Cost contribution based on drug categories were anti-infective (6%), cardiovascular (6%), central nervous system (including opiates, anti-nausea medications and antidepressants) (7%), blood formulations (including anticoagulants) (8%), hormones (8%) and gastrointestinal drugs (4%) respectively. Conclusions: Based on the real world information from a large insurance claims database, this study quantifies the contribution of various drug classes to the cost of cancer care. Antineoplastic contribute to > 1/3rd of the total pharmacy spending. With increasing trend for immunotherapy and combination therapy drug costs are bound to go up even more steeply. Unless drug prices are regulated, we are looking towards an unsustainable level of growth in the health care spending in cancer care.

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analysis & commentary How Health Care Reform Must Bend The Cost Curve

Health Affairs ◽

10.1377/hlthaff.2010.0416 ◽

2010 ◽

Vol 29 (6) ◽

pp. 1131-1135 ◽

Cited By ~ 46

Author(s):

David Cutler

Keyword(s):

Health Care ◽

Health Care Reform ◽

Cost Curve ◽

The Cost

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Reshaping the Health-Care State

Government and Opposition ◽

10.1111/j.1477-7053.1994.tb01267.x ◽

1994 ◽

Vol 29 (1) ◽

pp. 48-63 ◽

Cited By ~ 8

Author(s):

Michael Moran

Keyword(s):

Health Care ◽

Gross National Product ◽

Cost Of Care ◽

The State ◽

National Product ◽

Health Care Spending ◽

Power Structures ◽

Capitalist World ◽

The Cost

Health Care Has Been Called ‘The World's Most successful industry’. That success is long-standing. In every nation for which we have reliable long-term evidence the proportion of Gross National Product devoted to health care is much higher than was the cast a generation ago. The state has been central to that expansion. In all advanced industrial nations it regulates health care industries; in many it pays most of the cost of care; and in some it directly employs those who do the caring. In the 1980s, however, most countries tried to slow down the growth of health care spending, or even to cut it absolutely. The ‘health care state’ is as a consequence being reshaped across the advanced capitalist world: its power structures are changing; the conditions under which it funds and delivers services are being altered; and its relations with the ‘consumers’ of care are being transformed.

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We Can Teach How to Bend the Cost Curve: Lessons in Pediatric High-Value Health Care

10.1542/9781610025836-7_sub03 ◽

2021 ◽

pp. 139-142

Author(s):

Alison Volpe Holmes ◽

Michele Long ◽

James Stallworth

Keyword(s):

Health Care ◽

Cost Curve ◽

The Cost

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Minding Ps and Qs: The Political and Policy Questions Framing Health Care Spending

The Journal of Law Medicine & Ethics ◽

10.1177/1073110516684787 ◽

2016 ◽

Vol 44 (4) ◽

pp. 559-568

Author(s):

William M. Sage

Keyword(s):

Health Care ◽

Health Spending ◽

The United States ◽

Social Solidarity ◽

Health Care Spending ◽

Managed Competition ◽

Policy Goals ◽

State Budgets ◽

The Cost

Tracing the evolution of political conversations about health care spending and their relationship to the formation of policy is a valuable exercise. Health care spending is about science and ethics, markets and government, freedom and community. By the late 1980s the unique upward trajectory of post-Medicare U.S. health care spending had been established, recessions and tax cuts were eroding federal and state budgets, and efforts to harness market forces to serve policy goals were accelerating. From the initial writings on “managed competition,” through the failed Clinton health reform effort in the early 1990s, to the passage of the Affordable Care Act in 2010, the policy narrative of health spending acquired a superficial consistency. On closer examination, however, it becomes apparent that the cost problem has been repeatedly reframed in political discourse even during this relatively brief period. The clearest transition has been from a narrative centered on rationing necessary care to one committed to reducing wasteful care – although the role of accumulated law and regulation in perpetuating waste remains largely unrecognized and the recently articulated commitment to population health seems an imperfect proxy for explicitly developing social solidarity with respect to health and health care in the United States.

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