Can we Continue to Afford Access to Cancer Treatment?

Oncology is facing a crisis of affordability that is not sustainable. The economic burden of cancer is growing, as a result of the rising cancer incidence and increased survival, alongside growing investment in disease prevention, diagnosis and treatment. The prices of new cancer drugs continue to increase, placing growing pressure on many healthcare systems. The aim of this article is to explore the reasons why the cost of cancer care is increasing, and why this increase may become unsustainable unless changes are made. There are only limited options for future health spending. Finding ways to improve the allocation of existing resources to achieve the best outcomes for patients will be key to achieving sustainability, whilst safeguarding the continued development of new, effective cancer treatments. Currently, too many cancer drugs are approved without robust evidence of value, and spending more on treatments does not necessarily translate to improvements in health. For all new drugs, in addition to efficacy and safety, there should be a focus on value, with measured outcomes and pricing that ensures these drugs are affordable. Fundamental changes to healthcare systems and industry are needed to sustain cancer care and allow continued access to effective and safe treatments for all patients.

Download Full-text

What Happens when the Cost of Cancer Care Becomes Unsustainable?

European Oncology & Haematology ◽

10.17925/eoh.2017.13.02.108 ◽

2017 ◽

Vol 13 (02) ◽

pp. 108 ◽

Cited By ~ 4

Author(s):

Steven Simoens ◽

Wim van Harten ◽

Gilberto Lopes ◽

Arnold Vulto ◽

Klaus Meier ◽

...

Keyword(s):

Cancer Care ◽

Decision Makers ◽

Incremental Innovation ◽

Cancer Drugs ◽

Cancer Treatments ◽

Access To Treatment ◽

Scarce Resources ◽

Patients With Cancer ◽

Heavy Burden ◽

The Cost

Cancer places a heavy burden on healthcare systems. The cost of cancer drugs is increasing, driven largely by the introduction of new, ever more innovative cancer treatments. This raises questions about value for money and the future sustainability of cancer care, and presents significant challenges for decision-makers in providing all patients with access to treatments and effective new cancer medicines. The aims of this article are to provide an understanding of how sustainability in cancer care is defined, what signs indicate that the limits of sustainability are being reached, and what potential impact this may have on patients with cancer within Europe. Each country is faced with making difficult decisions about the allocation of healthcare resources to cancer care, to best meet the health needs of their patients. Determining the value of individual cancer drugs can help to inform these decisions, because premium pricing for incremental innovation is no longer sustainable. When the cost of cancer care becomes unsustainable, countries may be forced to restrict health expenditure by limiting demand, cutting spending and reducing investment. This can lead to restricted access to treatment. New, innovative cancer treatments must provide greater value than current options, and measures are needed to contain and reduce expenditure and make best use of scarce resources, without impeding access to effective and safe treatments for all patients.

Download Full-text

Why licensing authorities need to consider the net value of new drugs in assigning review priorities: Addressing the tension between licensing and reimbursement

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462308080197 ◽

2008 ◽

Vol 24 (02) ◽

pp. 140-145 ◽

Cited By ~ 12

Author(s):

Christopher McCabe ◽

Karl Claxton ◽

Anthony O'Hagan

Keyword(s):

Market Access ◽

Decision Rules ◽

Healthcare Systems ◽

New Drugs ◽

Priority Review ◽

Pharmaceutical Companies ◽

Net Benefit ◽

Positive Effects ◽

The Cost ◽

Do So

Pharmaceutical regulators and healthcare reimbursement authorities operate in different intellectual paradigms and adopt very different decision rules. As a result, drugs that have been licensed are often not available to all patients who could benefit because reimbursement authorities judge that the cost of therapies is greater than the health produced. This finding creates uncertainty for pharmaceutical companies planning their research and development investment, as licensing is no longer a guarantee of market access. In this study, we propose that it would be consistent with the objectives of pharmaceutical regulators to use the Net Benefit Framework of reimbursement authorities to identify those therapies that should be subject to priority review, that it is feasible to do so and that this would have several positive effects for patients, industry, and healthcare systems.

Download Full-text

The correlation between clinical benefit and financial cost of cancer drugs.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.7071 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 7071-7071

Author(s):

Aaron Philip Mitchell ◽

Sara Tabatabai ◽

Pranammya Dey ◽

Jennifer Ohn ◽

Michael A. Curry ◽

...

Keyword(s):

Clinical Benefit ◽

Treatment Cost ◽

Treatment Costs ◽

Value Assessment ◽

Cancer Drugs ◽

Cancer Treatments ◽

Quality Of Evidence ◽

Treatment Indications ◽

The Cost

7071 Background: The cost of many cancer drugs is very high, but it is unclear if these costs are associated with commensurate improvement in outcomes. We aimed to assess the association between the cost of cancer treatments and their clinical benefit, using the NCCN Evidence Blocks value assessment framework. Methods: The NCCN Evidence Blocks include 4 measures of clinical benefit: Efficacy, Safety, Quality of Evidence, and Consistency of Evidence. The NCCN assigns scores on each measure ranging from 1 (least favorable) to 5 (most favorable). We obtained the NCCN Evidence Blocks scores as of December 31, 2018 for all recommended cancer treatments for the 30 most prevalent cancers in the US. For each treatment, we calculated total treatment costs (including drugs, administration fees, and supportive care medications) using Medicare reimbursement rates. We categorized treatments as either “time-limited” or “time-unlimited” according to whether their costs are best reflected as per full treatment course (often, adjuvant/neoadjuvant treatments) (time-limited) or per month of therapy (often, treatments for advanced disease) (time-unlimited). We used generalized estimating equations, with clustering within treatment indications, to estimate the association between Evidence Blocks scores and treatment costs, modeling the expected change in cost associated with a one-unit increase in the score on an Evidence Blocks measure. Results: There were 541 time-unlimited and 845 time-limited treatments. Among time-unlimited treatments, monthly treatment cost ranged from $4 to $64,630. Monthly treatment cost was positively associated with Efficacy ($3,036, 95%CI: $1,782, $4,289) and Quality of Evidence ($1,509, 95%CI: $171, $2,847) but negatively associated with Safety (-$1,470, 95%CI: -$2,790, -$151) and Consistency of Evidence (-$2,003, 95%CI -$3,420, -$586). Among time-limited treatments, cost per course of therapy ranged from $0 to $775,559, and no measure was significantly associated with cost. Evidence Blocks scores accounted for little of the variation in treatment cost (linear model R-squared = 0.10 for time-unlimited, and < 0.01 for time-unlimited). Conclusions: The association between NCCN Evidence Blocks measures and treatment cost was inconsistent, and accounted for little of the cost variation among treatments for the same indication. The clinical benefit of cancer treatments does not appear to be a primary determinant of treatment cost, suggesting that current pricing models may be inadequate to incentivize the development and utilization of high-value treatments.

Download Full-text

Development and economic trends in cancer therapeutic drugs: An updated analysis of modern and historical treatment costs compared to the contemporary GDP per capita.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.259 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 259-259 ◽

Cited By ~ 1

Author(s):

Philip Savage

Keyword(s):

Cancer Treatment ◽

Standard Treatment ◽

New Drugs ◽

Gdp Per Capita ◽

Cancer Drug ◽

Cancer Drugs ◽

Per Capita Gdp ◽

Per Capita ◽

New Treatments ◽

The Cost

259 Background: Cancer drug development is a major industry and clincial success story with new cancer treatment drugs delivering improved healthcare for many more patients each year. Generally new cancer treatment drugs are viewed as being of 'high cost' and there is considerable debate as to how these new treatments can be funded for routine use. Accurate data on the trends of the relative costs of new treatments compared with earlier high cost cancer drugs is limited. In this sudy we have aimed to document all the newly licenced cancer drugs, by year of introduction, and compare the cost of a standard course of treatment relative to the current per capita GDP to allow an assessment of how relative costs of new drugs have changed over time. Methods: Drugs are classified by years of introduction, therapeutic classification, and an assessment of relative treatment cost using a contemporary 'standard' treatment compared with the relevant UK GDP per capita. Results: Prior to 1960, there were 5 cancer drugs available, 2 new drugs were introduced in the 1960s, 18 in the 1970s, 14 in the 1980s, 24 in the 1990s, 23 between 2000-2009 and 15 between 2010-12. Data will be presented on the cost relative to per capita GDP of a standard treatment for each new drug released from 1987 to current. The summary data indicates that the cost at introduction of an average new cancer drug treatment has increased from 33% of per capita GDP for 1995-99, 53% for 2000-2004, 67% for 2005-2009 and is now 114% for 2010-2012. Conclusions: The cost of new cancer drug treatments appears to be rising in absolute and relative terms. The data in this abstract may be of value to those interested in the history of cancer treatment development and the associated current economic issues.

Download Full-text

United States physician communication on cost of cancer care under the affordable health care act

Journal of Hospital Administration ◽

10.5430/jha.v3n5p182 ◽

2014 ◽

Vol 3 (5) ◽

pp. 182

Author(s):

Laura L. Tenner ◽

Aaron E. Carroll ◽

Paul R. Helft

Keyword(s):

United States ◽

Healthcare System ◽

Cancer Care ◽

Physician Education ◽

Cancer Treatments ◽

Electronic Survey ◽

Physician Perceptions ◽

The Cost ◽

Effectiveness Data ◽

Out Of Pocket Costs

Background: The aim of this study is to survey United States oncologists as healthcare system changes are implemented to reassess physician perceptions about the cost of cancer care and physicians’ perceived needs.Methods: From June through August of 2013, an electronic survey was sent to practicing oncologists across 50 states.Results: The electronic survey response rate was 15% (136 oncologists out of 899 total physicians) with respondents from 35 of the 50 states. Sixty percent of respondents thought that both out-of-pocket costs and healthcare system costs of cancer treatments were likely or extremely likely to have a larger effect on their decisions regarding which cancer treatments to recommend to patients in the future under the Affordable Care Act (ACA). A large majority of respondents felt that physician education was needed on the use of cost-effectiveness data and on communicating cost of therapies with patients, 91% and 85%, respectively.Conclusion: Respondents reported that their clinical treatment decisions are influenced by concerns over out-of-pocket patient costs, and that they want more cost and comparative effectiveness research as well as more education on how to communicate with patients about cost of therapy.

Download Full-text

Advances in Applying Computer-Aided Drug Design for Neurodegenerative Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms22094688 ◽

2021 ◽

Vol 22 (9) ◽

pp. 4688

Author(s):

Mootaz M. Salman ◽

Zaid Al-Obaidi ◽

Philip Kitchen ◽

Andrea Loreto ◽

Roslyn M. Bill ◽

...

Keyword(s):

Drug Design ◽

Neurodegenerative Diseases ◽

Docking Studies ◽

New Drugs ◽

Computer Aided Drug Design ◽

Biological Assays ◽

Advantages And Disadvantages ◽

Computer Aided ◽

Research Challenge ◽

The Cost

Neurodegenerative diseases (NDs) including Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, and Huntington’s disease are incurable and affect millions of people worldwide. The development of treatments for this unmet clinical need is a major global research challenge. Computer-aided drug design (CADD) methods minimize the huge number of ligands that could be screened in biological assays, reducing the cost, time, and effort required to develop new drugs. In this review, we provide an introduction to CADD and examine the progress in applying CADD and other molecular docking studies to NDs. We provide an updated overview of potential therapeutic targets for various NDs and discuss some of the advantages and disadvantages of these tools.

Download Full-text

Tofacitinib: An Option for Acute Severe Ulcerative Colitis?

GE Portuguese Journal of Gastroenterology ◽

10.1159/000514781 ◽

2021 ◽

pp. 1-3

Author(s):

Sara Santos ◽

Verónica Gamelas ◽

Rita Saraiva ◽

Guilherme Simões ◽

Joana Saiote ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Improvement ◽

Rescue Therapy ◽

New Drugs ◽

Multiple Drug ◽

Disease Course ◽

Efficacy And Safety ◽

Severe Ulcerative Colitis ◽

Rapid Absorption

Tofacitinib has emerged as a new option for ulcerative colitis. Its rapid absorption, metabolism, and clinical improvement make it an interesting option for rescue therapy in acute severe ulcerative colitis (ASUC), a situation with limited therapeutic options in patients with a long-term disease course and multiple drug failure. The management of ASUC in this setting becomes challenging, underlying the need for new drugs and data on their efficacy and safety. We describe 2 cases of acute episodes in which tofacitinib was used as a rescue therapy.

Download Full-text

Bioactive Terpenes and Their Derivatives as Potential SARS-CoV-2 Proteases Inhibitors from Molecular Modeling Studies

Biomolecules ◽

10.3390/biom11010074 ◽

2021 ◽

Vol 11 (1) ◽

pp. 74

Author(s):

Lúcio Ricardo Leite Diniz ◽

Yunierkis Perez-Castillo ◽

Hatem A. Elshabrawy ◽

Carlos da Silva Maia Bezerra Filho ◽

Damião Pergentino de Sousa

Keyword(s):

Natural Products ◽

Healthcare Systems ◽

New Drugs ◽

Therapeutic Approaches ◽

Elderly Individuals ◽

Global Challenge ◽

Molecular Modeling Studies ◽

Human Coronaviruses ◽

Novel Coronavirus ◽

Chronic Comorbidities

The coronavirus disease 2019 (COVID-19) pandemic is caused by a novel coronavirus; the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Millions of cases and deaths to date have resulted in a global challenge for healthcare systems. COVID-19 has a high mortality rate, especially in elderly individuals with pre-existing chronic comorbidities. There are currently no effective therapeutic approaches for the prevention and treatment of COVID-19. Therefore, the identification of effective therapeutics is a necessity. Terpenes are the largest class of natural products that could serve as a source of new drugs or as prototypes for the development of effective pharmacotherapeutic agents. In the present study, we discuss the antiviral activity of these natural products and we perform simulations against the Mpro and PLpro enzymes of SARS-CoV-2. Our results strongly suggest the potential of these compounds against human coronaviruses, including SARS-CoV-2.

Download Full-text