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Tuesday, June 21, 2016

Getting Past No in Cancer Care (U.S.)



pdf
June 20, 2016
 Office of the Chief Medical Officer, Aetna, Hartford, Connecticut, USA

 The rising cost of cancer care, and especially the rising cost of
cancer drugs, is widely held to be unsustainable. At the heart of
this debate is the belief that the benefit society is receiving is
out of register with the cost—that we are not getting good
value—and there is evidence to support that view [1]. This is
not a debate about the amazing progress that has been made
in the fundamental understanding of cancer or on the breathtaking
outcomes achieved with some of the new targeted
therapies or immuno-oncologic agents. Rather, it is the concern
that many of the new therapies being brought to market are
priced at a premium irrespective of clinical impact, resulting in
a fundamental misalignment between cost and benefit. In his
payer perspective, Dr. Newcomer [2] proposes solutions to the
frequently discussed challenge of controlling the rapidly increasing
costs of cancer care. He reviews why the free market has
failed (i.e.,because it is not really a free market).He goes onto
delineate four specific “simple” steps: (a) eliminate coverage
mandates; (b) allow for true comparative effectiveness and
cost-effectiveness research; (c) eliminate site of service differentials;
and (d) build a rapid learning system, apply it initially
to personalized medicine, and empower it to be a major tool
of clinical research. Each of these has merits, but each has
shortcomings, particularly when considering the pragmatic
perspective of “how to get it done.” It is not merely, as the author
suggests, a matter of “commitment, rigor, andc ourage.”Most of
the proposals impact the cost of cancer care but only indirectly
address the cost ofc ancer drugs. It behooves us to consider each
in turn, as well as in the context of numerous other proposed
solutions.....

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