paywalled: Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]

Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]:

Purpose:
Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans.

Conclusion:
Among 21 oral oncolytics, average OOP cost ranged from $15 to > $500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.

Higher US expenditures on cancer patients do not result in improved mortality. : denialism blog

Higher US expenditures on cancer patients do not result in improved mortality. : denialism blog

                                    ~~~~~~~~~~~~~~~~

Blogger: Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.

                               ~~~~~~~~~~~~~~~~~~~~~
Higher US expenditures on cancer patients do not result in improved mortality.

" But you'd never know that reading AEI's highly dubious contribution to the literature in this week's Health Affairs (lay Reuters article here). Consistent with their free-market solves everything and can do no wrong (cover ears and yell "nananananananana") attitude towards the broken US healthcare system, they have managed to contaminate the literature with a paper that suggests our higher expenditures on cancer are generating significant returns in patient survival. Except that it doesn't show this, and to her great credit, Reuter's Sharon Begley nails it:........

"Experts shown an advance copy of the paper by Reuters argued that the tricky statistics of cancer outcomes tripped up the authors.
"This study is pure folly," said biostatistician Dr. Don Berry of MD Anderson Cancer Center in Houston. "It's completely misguided and it's dangerous. Not only are the authors' analyses flawed but their conclusions are also wrong."

".... It's been a topic of debate among medical professions and discussed extensively by other medical bloggers like Ora.....(Blogger's Note: see prior postings)

JCO abstract: Understanding Patients' Attitudes Toward Communication About the Cost of Cancer Care

 Blogger's Note: semantics - 'most'/'majority' requires language editing eg. majority 68%, most 59% (language bias?)

Understanding Patients' Attitudes Toward Communication About the Cost of Cancer Care

Abstract

Purpose: Recent publications have promoted physician-patient communication on cost as a means of decreasing overall spending and minimizing patients' financial burden in oncology. No study has assessed patients' perspectives on cost communication in oncology......

Results: Of the 771 patients approached, 256 responded (response rate, 33%). Most (68%) preferred to know about out-of-pocket costs before treatment. A majority (59%) wanted their physician to discuss these costs with them. Although 76% reported feeling comfortable discussing cost with their physician, 74% were amenable to discussing cost with someone other than their physician. Most patients did not consider out-of-pocket costs (57%) or the health care costs of the country (61%) in their decision making, nor did they believe their physician should (55%). Patients receiving active chemotherapy were less likely to want to discuss out-of-pocket costs with their physician (P = .035). 

Conclusion: Patients' comfort with and desire to discuss cancer costs exceed that of oncologists, suggesting a need to educate oncologists on this important topic. A patient's desire to understand treatment-associated cost does not equate with a desire for cost to influence medical decision making.

US Oncologists Confront Pressure to Curb Cancer Costs - OncologySTAT

abstract: Cost-effectiveness of combination versus sequential docetaxel and carboplatin for the treatment of platinum-sensitive, recurrent ovarian cancer

CONCLUSIONS:

Combined weekly cDC (concurrent docetaxel and carboplatin) appeared to be cost-effective compared with sDC (sequential docetaxel and carboplatin ) as treatment strategy for patients with platinum-sensitive ovarian cancer, even when accounting for slightly lower QoL during treatment.

The cost of drugs: breaking the bank to stay alive - The Globe and Mail

blog: Taking a Stab at Cost-Effectiveness | Work In Progress

"....With an aim toward making some small step forward in that direction, Cohn et al tried analyzing the cost-effectiveness of Avastin in the treatment of ovarian cancer. (I know I’ve written about Avastin here before, and I don’t mean to pick on this drug, as if it is the richest child on the fancy pharmaceutical playground. This kind of analysis works well here because the high-priced drug acts almost like a caricature for cost considerations in general.)..."

abstract JCO: At What Cost Does a Potential Survival Advantage of Bevacizumab Make Sense for the Primary Treatment of Ovarian Cancer? A Cost-Effectiveness Analysis

Abstract

Purpose 

To determine whether the addition of bevacizumab to paclitaxel and carboplatin for the primary treatment of advanced ovarian cancer can be cost effective.

 Conclusion:

  The addition of bevacizumab to standard chemotherapy in patients with advanced ovarian cancer is not cost effective. Treatment with maintenance bevacizumab leads to improved PFS but is associated with both direct and indirect costs. The cost effectiveness of bevacizumab in the adjuvant treatment of ovarian cancer is primarily dependent on drug costs.

Ohio State study: Targeted ovarian cancer therapy not cost-effective (Bevacizumab/Avastin)

Note: read the whole article
 ------------------------------------------------------------------------------------
Ohio State study: Targeted ovarian cancer therapy not cost-effective

COLUMBUS, Ohio – An analysis conducted by Ohio State University cancer researchers has found that adding the targeted therapy bevacizumab to the treatment of patients with advanced ovarian cancer is not cost effective.

The findings comparing the relative value of various clinical strategies will be published online March 7 in the Journal of Clinical Oncology (see blog)................ cont'd

"Although a discussion regarding cost-effectiveness of a potentially life-extending intervention invariably suggests the rationing of limited health care resources, the intent of this study was to provide a framework with which to evaluate the pending results of a clinical trial of three different interventions for ovarian cancer, said Cohn."............... cont'd

Cancer Prevalence and Cost of Care Projections - Interactive Guide NCI (via WSJ link)

Key Facts

• 18.1 million cancer survivors in 2020, 30% more than 2010
• Costs of cancer care: $157 billion in 2010 dollars
• Growth and aging of the U.S. population is the primary cause

Create Your Own Chart

Graph by Cancer Site and Phase of Cancer
(See cost of care or prevalence for cancer site, sex, age and year under various assumptions)

Projection Tables for 2020

National Expenditures for Cancer Care
Cancer Prevalence

Base Data

Average Annual Costs of Care

Cancer-Care Costs Could Hit $207 Billion in 2020: NCI Study - Health Blog - WSJ

"....Statistical modeling, of course, depends on the assumptions used by the researchers — so check out the full study to see those details. And here’s an interactive tool that allows you to change some of the assumptions."

Projections of the Cost of Cancer Care in the United States: 2010–2020 — J. Natl. Cancer Inst.

excerpt/also see Table 5 for projection (cost) estimates:

Recent and Projected Incidence

For most of the cancer sites, incidence has been decreasing, and we estimated a negative annual percent change (Table 1) during the period 1996–2005. The largest decreases in men were for lung, stomach, and colorectal cancers, respectively, −2.72, −2.24, and −2.22 annual percent change in age-adjusted rates. More dramatic decreases were observed for women for ovarian and cervical cancer, −4.71 and −3.95, respectively, annual percent change in age-adjusted rates. Incidence of kidney cancer and melanoma has been increasing in both men and women, and incidence of lymphoma and brain cancer has been increasing in women (Table 1). Among the five major cancer sites, the largest decreases in incidence were observed for lung and colorectal cancers in men, −2.72 and −2.22, respectively, annual percent change in age-adjusted incidence rates (Figure 1; Similar figures for more cancer sites are available at http://costprojections.cancer.gov.).

View this table:

• In this window
• In a new window

Table 1

Incidence and survival trends used in the incidence and survival trend scenario*

The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review

CONCLUSION: Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.

Comments | Decisions at the end of life: have we come of age? full free access - open for commentary

Decisions at the end of life: have we come of age?

Linda Emanuel and Karen Glasser Scandrett

BMC Medicine 2010, 8:57doi:10.1186/1741-7015-8-57

Blog addressing educational, research and genetics needs in ovarian cancer/related populations

(Commentary) Sandi Pniauskas (19 October 2010) Ovarian Cancer and Us
Congratulations to the authors for addressing the issue of changing values and needs of patients at the close of life. Most North American studies on this topic err in their original suppositions regarding the preferred place of death. Generally the focus has been institutional and cost based as opposed to the values and ethics of yes, human dignity in dying. Specific to the needs of oncology patients/families, it is often disturbing to view reports asking citizens where they wish to die when we should know and understand that this answer cannot be of any value until those patients and families are 'in the moment'. The moment-to-moment changes in physical and emotional changes in cancer patients/families and all of the psycho-physio changes require that our systems adapt. Numerous real life examples of institutional/provider interference in the wishes of the dying are disturbingly unconscionable. The question which needs to be addressed is: 'Who's on 'first'?" Having witnessed circumstances where best practices were not followed in favour of cost analyses, we have to ask ourselves who will say no to money before suffering?
Competing interests
ovarian cancer survivor, Lynch Syndrome

Perspective: Can We Treat Cancer for a Dollar a Day? Guidelines for Low-Income Countries — NEJM

The American Cancer Society And LIVESTRONG(R) Launch First Global Economic Cost Of Cancer Report

Understanding Patient Perspectives on Communication About the Cost of Cancer Care: A Review of the Literature — JOP

Conclusion: To my knowledge, patient preferences surrounding discussion of cost of cancer care have gone largely unstudied and are thus unknown. If the goal is to provide high-quality care while controlling rising health care costs, more research is needed to better understand patient perspectives on communication surrounding the cost of oncologic care, particularly given the significant impact such discussions may have on cancer outcomes, cost, and overall patient satisfaction.