Trends and issues in oncology costs

Abstract

Approximately 18% of US gross domestic product is spent on healthcare and 5% of that is for cancer care. With rapidly increasing oncologic drug prices, growth in cancer spending will likely far outpace overall healthcare spending growth. Developing cost-saving strategies is imperative, but economizing must not compromise patients’ well-being. Providing quality care at the most economical price is the main aim. This article summarizes trends in rising cancer costs, and reviews cost-management strategies, including those proposed in the Affordable Care Act. Many programs economize by correcting inefficiencies, preventing therapeutic failures and eliminating errors. Process improvement is important, but in oncology, medications substantially drive costs. Identifying the most effective and economical treatments requires cost-effectiveness research. At the current pace, the US payers cannot continue to afford increasing costs for cancer treatments. Research on maximizing patient outcomes for reasonable costs is essential. More analyses of quality of life assessment and cost-effectiveness can support future decisions about cancer care.

Keywords::

• cancer
• chemotherapy
• clinical pathway
• cost-effectiveness research
• disease management
• oncologic
• oncology
• pay-for-performance

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Cancer-related costs account for over a fifth of all healthcare costs in the USA, and are rising at a faster pace than overall healthcare costs.

• Each year more patients are being treated for cancer, and, at the same time, cancer treatment costs per patient are increasing.

• Cost-restriction measures have had limited success and have raised concerns about their effects on the quality of patient care.

• More recently, payers have shifted their attention to cooperative, quality-focused approaches, such as clinical pathways, disease management programs and pay-for-performance strategies to achieve savings by minimizing healthcare waste.

• Development of performance standards predictive of improved outcomes has been difficult in oncology, by virtue of its heterogeneity, but comparative effectiveness research will help to clarify how patient and practice variables are related to outcomes.

• With the cost of oncology drugs rising rapidly, effective cost-management requires thorough evaluation of financial, as well as clinical outcomes, especially in light of potential policy changes resulting from healthcare reform.

• Some movement has been made toward end-of-life palliative treatment, in lieu of rescue treatment, as an approach that may offer superior value in terms of both quantity and quality of life.