Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

Health Services and Outcomes

Continental Divide? The Attitudes of US and Canadian Oncologists on the Costs, Cost-Effectiveness, and Health Policies Associated With New Cancer Drugs

From the Sunnybrook Odette Cancer Center; University of Toronto; Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Clinical Evaluative Sciences, Toronto; McMaster University; Juravinski Cancer Center at Hamilton Health Sciences, Hamilton; Peel Regional Cancer Center, Mississauga, Ontario, Canada; University of Michigan School of Medicine, Ann Arbor, MI; Charles Sammons Cancer Center, Baylor University Medical Center, Dallas, TX; and the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.


ABSTRACT

Purpose Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy.

Methods Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared.

Results Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. 

(blogger's usual take (based on abstract): and patients in the determination process ??)

 






Conclusion Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

Interfaces Across the Cancer Continuum Offer Opportunities to Improve the Process of Care -- JNCI (pay-per-view - excerpt only)

Note: comparisons U.S./Canada

NGC - Compare - NATIONAL GUIDELINE CLEARINGHOUSE™ (NGC) GUIDELINE SYNTHESIS SCREENING FOR OVARIAN CANCER

"This synthesis was prepared by ECRI Institute on October 2, 2007. It was reviewed by SIGN on October 10, 2007, UMHS on October 25, 2007, and ACR on November 2, 2007. The synthesis was updated in April 2010 to remove UMHS and USPSTF recommendations and to update ACR recommendations. The information was verified by ACR on June 2, 2010."

Canada playing in wrong health league - Michael Rachlis

Note: article relates to the  U.S.-based Commonwealth Fund report of June 25th, 2010 (see prior blog post); this was not the first Commonwealth Fund analysis which compared different countries on a variety of indices with Canada and the U.S. coming in dead last in overall rankings.

"The report compared Canada with other countries 18 times in the text. These included two favourable comparisons and 16 unfavourable ones, including indictments for long waits, the poor management of chronic conditions (like diabetes), the lack of electronic systems, poor care coordination and the failure to involve patients in decisions about their care."
Dr. Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.

abstract: Unambiguous test results or individual independence? The role of clients and families in predictive BRCA-testing in the Netherlands compared to the US

2010 the Commonwealth Fund report: MIRROR, MIRROR ON THE WALL: AN INTERNATIONAL UPDATE ON THE COMPARATIVE PERFORMANCE OF AMERICAN HEALTH CARE

Overall rankings: Canada and U.S. in last place, Netherlands takes 1st place

Survival in women with MMR mutations and ovarian cancer: a multicentre study in Lynch syndrome kindreds -- Grindedal et al. 47 (2): 99 -- Journal of Medical Genetics

Conclusions: In the series examined, infiltrating ovarian cancer in Lynch syndrome had a better prognosis than infiltrating ovarian cancer in BRCA1/2 mutation carriers or in the general population. Lifetime risk of ovarian cancer of about 10% and a risk of dying of ovarian cancer of 20% gave a lifetime risk of dying of ovarian cancer of about 2% in female MMR mutation carriers.

Wait Times For Medical Care: How The US Actually Measures Up - Better Health

Note: ACOR ovarian cancer members - the report will be in the archives - Commonwealth Fund