22
Mar
10

Cancer costs breaking the bank?

Recent figures compiled by the Kaiser Foundation’s Medical News from a number of sources highlight how much the cost of cancer treatment has jumped in the last decade or so.

USA Today: “The cost of cancer treatment is ‘skyrocketing’ — both for individual patients and the nation, a new analysis shows. From 1990 to 2008, spending on cancer care soared to more than $90 billion from $27 billion. The increase was driven by the rising costs of sophisticated new drugs, robotic surgeries and radiation techniques, as well as the growing number of patients who are eligible to take them, says Peter Bach of New York’s Memorial Sloan-Kettering Cancer Cancer, co-author of an analysis in today’s Journal of the American Medical Association.

HealthDay News: “New chemotherapy agents for metastatic colon cancer improve patient survival but are costly, says a new study. Researchers at Emory University in Atlanta analyzed data from 4,665 patients, aged 66 and older, diagnosed with metastatic colon cancer between 1995 and 2005. Compared to those who received older chemotherapy agents, patients who received one or more of the six chemotherapy agents approved in the United States between 1996 and 2004 lived an average of 6.8 months longer. That increase in survival was associated with a lifetime cost increase of $37,100, which equates to $66,200 per year of life gained.”

As I’ve said before, one of the big surprises of my career in cancer public health was that cost would become as big a barrier to achieving reduction in cancer mortality as some of the characteristics of the disease itself. Between the early 1970s and maybe 2000 the cancer  control community never talked about cost. The advocacy organization I worked for kept focused on the rather idealistic goal of finding the cures for cancer and making them available regardless of the expense. That wasn’t seen as our concern.

Then the disparities in survival rates among ethnic groups began to show up, an indicator that is pretty closely associated with income. After that, the really expensive “targeted therapies” started to come out of the biotechnology companies. The shockingly high cost of rounds of treatment with the highly engineered molecules designed to disrupt specific cell growth “pathways” in cancer cells was a jaw-dropper. The first impulse was to condemn the biotech companies for greedy profiteering. I happened to be familiar with some of the main companies in the SF Bay Area, so I heard the other side of the story from them. I realized that it is not at all easy or cheap to pursue that way of dealing with cancer. I think we have to look at the drugs out there now as experimental drugs, almost research. There may be reason to hope that the technology for this will improve and drop in cost over time…but I wouldn’t bet the farm on it.

In the last year or so that I worked in the cancer community I began to say that — as an advocacy organization — we had a responsibility not only to push for progress on the disease but to develop recommendations as well for how to do it that took into consideration real-world issues like the overall cost. I doubt that many advocacy organizations in health have costed-out their goals in society-wide economic terms. I’m hoping that the rancor of the health insurance reform debate that is going on is also an eye-opener for nonprofit health organizations. Advocacy organizations tend to get tunnel vision. They need to step back and look at where their cause fits in the bigger picture of all the other needs.

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