Study Indicates Higher Drug Costs and Comparative Effectiveness Affect Cancer Treatment Recommendations

A survey of close to 800 oncologists in the United States carried out by researchers from the University of Michigan and Tufts Medical Center has provided an insight into factors influencing therapy recommendations, and specifically the link to costs. The premise of the study was to assess oncologists' attitudes towards cancer-drug costs and cost-effectiveness, as well as engaging their opinions in relation to prospective public health policies on comparative-effectiveness research. The results provide some interesting verifications on prescribing trends.

The Three Cs—Costs, Communication, and Comparative Effectiveness

Cost factors influencing recommendation: Specific questions over the significance of costs in therapy decision-making showed that 84% of oncologists maintained that out-of-pocket costs currently influenced decisions on therapy. Furthermore, a high percentage of oncologists—73%—noted that in the next five years costs of new cancer drugs will play a role in therapy recommendations. Interestingly, only half of the respondents opined that costs of new drugs will influence recommendation decisions. Worryingly for pharma firms, 57% favoured a government price control for Medicare cancer therapies.

Comparative effectiveness and cost effectiveness: The results indicated that most oncologists supported the concept of comparative-effectiveness research and cost-effectiveness data to help make treatment decisions. However, there was a general acknowledgement of lack of understanding over how to interpret data. This signifies a potentially major concern among healthcare professionals, as the debate over usage of comparative-effectiveness data intensifies.

Communication problems: While interpreting economic data is a problem, physicians have also admitted that communicating the rationale behind recommendations to patients is another area of concern. Given that most oncologists put "out-of-pocket" expenditure high on their list of factors influencing recommendation of therapies, it is interesting that to note that only 43% of the respondents discussed the issue with their patients.

Source: Health Affairs.

Published survey and discussions can be accessed here.

Outlook and Implications

The concern over costs is not a new one, particularly for cancer therapies. In recent times, the issue of expensive cancer drugs has gained much traction as health authorities have dealt with the dilemma of care requirement versus limited resources. During the recent recessionary climate, this factor has been accentuated and brought to the fore, reflected in federal drug-reimbursement policies in Europe. In the United States, the cost factor has emerged as a key issue of the awaited Health Reform Bill.

For pharmaceutical firms, while it is no surprise that treatment costs play a role in therapy recommendations, the study's findings reflect the challenges for oncology drug reimbursement under health plans for existing therapies and, more importantly, for new therapies hitting the market. It has been highlighted that payers are seeking to cap expenditure on oncology drugs and increasingly placing more emphasis on evidence-based research. The mood is certainly reflected in the survey itself, wherein support for the comparative-effectiveness research and cost-effectiveness data is increasing. This essentially bolsters plans under the Health Reform Bill to set up a comparative-effectiveness research centre to address these issues and provide the much-needed support to physicians on appropriate use of therapy. These efforts will make it a very challenging environment for innovative drug companies, but research investments are not expected to drop as a result. In terms of potential drug price controls on federal health insurance programmes, such as Medicare and Medicaid, direct interference is not envisaged. However, pressures will be brought to bear with emphasis on patient preferences, quality of care, and, importantly, clinical aspects. These factors are expected to be cornerstones for further healthcare delivery services for cancer patients.

Related Articles

• United States: 13 January 2010: Evidence-Based Care Brings 35% Cost Savings in NSCLC Patient Care in U.S., Study Finds
• United States: 12 January 2010: GAO Assesses Drug Price Rises in New Study