Stunningly, some of the most dramatic gains in cancer survival rates have occurred among patients with certain cancer types, such as metastatic non–small cell lung cancer (NSCLC), for which survival outcomes were poor historically. At this time, however, our abilities to effectively deliver these extraordinary advances are challenged by the rapidly escalating costs of care, continued disparities in cancer survival outcomes, and care payment and deliver systems that erect barriers for patients and families trying to access the care they need.
Rising costs are a significant challenge to the financial sustainability of health care payers, including state and local governments, private health plans, and employers. One major success story in cancer care has been the rapid pace of development of novel, innovative anticancer therapeutics and immuno-oncological agents. Authors of the IQVIA report, “Global Oncology Trends 2019,” note that between 2016 and 2018 the number of patients who were treated with immuno-oncologic treatments doubled to over 200,000 patients in 2018.2 Additionally, they write:
The pipeline of drugs in late-stage development expanded 19% in 2018 alone, and 63% since 2013. Within the pipeline, across all phases of clinical development, the most intense activity is focused on nearly 450 immunotherapies with more than 60 different mechanisms of action. Ninety-eight next-generation biotherapeutics—defined as cell, gene and nucleotide therapies—are also under clinical investigation and leverage 18 different approaches. The combined immunotherapies and next-generation biotherapeutics are targeting almost all cancer tumor types with over 80 mechanisms of action.2
The IQVIA authors, however, make the sobering observation that in 2018 the average cost of a new oncology drug was $140,000, with new drug costs potentially exceeding $300,000 annually.2 Moreover, a survey of Medicare Part B oncology drug pricing, the pricing of 24 index anti-cancer drugs rose an average of 25% between 1996 and 2012 (18% after adjustments for inflation), even after generic drugs became available.4
Another contributing factor to higher, nonvalued added health care costs is the impact of low-value care delivery. This includes the issue of interclinician variability in treatments for patients. A 2019 analysis of CMS/Medicare data for claims related to 3,159,834 Medicare beneficiaries found that physician practice may contribute substantially to the delivery of low value care.5 While this CMS data analysis was performed for patients receiving care in from generalist physicians, the issue is also present in the domain of cancer care. In an analysis of 5651 women with stage breast cancer with secondary metastatic disease, nearly 1 in 5 received care that was not concordant with treatment guidelines adopted by the National Comprehensive Cancer Network. “Nonconcordant treatment was associated with higher health care utilization and costs, with mortality…