By Sue Rochman
Cost vs. Effectiveness
When deciding whether a cancer drug is worthwhile, should we consider its cost?
By Sue Rochman
Which tests and treatments for cancer are truly effective?
The answer is elusive, which is why health policy experts are now focused on a field of research that relies on scientific data to determine which tests and treatments work best for individual patients. Comparative effectiveness research, as it’s known, has the potential to improve patient care and rein in costs—and it has become a centerpiece of U.S. health policy.
But many policy experts argue that to truly control costs, researchers must also evaluate cost effectiveness. This means weighing how much benefit is provided for a treatment’s cost.
Not surprisingly, it’s controversial to talk about cost along with a cancer drug’s effectiveness. “Many people are uncomfortable bringing cost to the table,” notes Peter Neumann, a health policy specialist at Tufts Medical Center in Boston. “People don’t want to consider these economic factors so explicitly and then deny care for those [for] whom treatment is deemed not cost effective.”
It’s not clear if considering cost effectiveness, as the United Kingdom does, decreases life expectancy for cancer patients. However, it does give patients fewer options. A study comparing cancer drug coverage in the U.S. and the U.K. published July 10 in the Journal of Clinical Oncology (JCO ) confirmed, as the authors noted, “the widely held belief among Americans that the introduction of economic evaluation … can lead to restrictions in access to anticancer drugs.”
In June, for example, the U.K.’s National Institute for Health and Clinical Excellence issued the decision that use of Tykerb (lapatinib) with Xeloda (capecitabine) for treating advanced HER2–positive breast cancer was not cost effective. The combination has been shown to extend life by a median of 10 weeks. It is approved and covered by insurance companies in the U.S., and costs an insurer about $2,900 a month.
But although more cancer treatments are available in the U.S. than in the U.K., many Americans can’t afford the copayments. Copays for Tykerb, for example, can be $200 or more per month.
It’s also not known if drug availability improves overall survival. The U.S. does have better survival rates for cancer than Europe, notes the JCO study’s lead researcher, Anne Mason, a health economist at the University of York in the U.K. But drug access may not be the reason. Because the U.S. conducts more screenings, she explains, cancers may be detected earlier, which “increases the length of time between diagnosis and death, even if the point of death does not change.”
The difficult choices involved make it easy to understand why people cringe at the idea of addressing cost effectiveness. It requires asking hard questions: Is the potential to extend one person’s life for two months worth any cost? Or, is it better to ensure that all people have access to cost-effective drugs and relatively inexpensive cancer screening tools? What are our values? Who decides? There are no easy answers.