Bankrupted by cancer: Why “cost” is an important criterion in our review process

The following is a guest blog post by Harold DeMonaco, the Assistant Chief Medical Officer for Care Transitions at the Massachusetts General Hospital. He has been one of our most active reviewers and guest bloggers throughout our 9+ year history.

Closeup Money rolled up with pills falling out, high cost, expensive healthcareDiscussion of cost is one of the criteria that uses to judge the quality of news stories about medical treatments.  This month’s edition of the Mayo Clinic Proceedings contains a commentary authored by no fewer than 116 of the country’s leading oncologists related to cost of care that deserves some additional attention from the news media.

The authors, who are from some of the most prestigious cancer centers, speak to what is all too familiar to cancer patients and their families: cancer treatment can bankrupt a family quickly.  The cost of cancer treatment has escalated to the point that it exceeds the average American’s ability to pay, even with insurance coverage. Out-of-pocket expenses, even with good insurance, can exceed $25,000 to $30,000 annually.  The commentary is entitled, “In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs.”

Here are some of the rather sobering points made in the commentary:

  1. Cancer will impact just about every person in the US either directly or indirectly. It is not disease mongering to point out that 1 out of every 3 will experience cancer in their lifetime
  2. Insurance deductibles and co-pays are increasing with subscriber contributions to care commonly in the 20-25% range
  3. All of the drugs used to treat cancer approved by the Food and Drug Administration in 2014 were priced in excess of $120,000 per year of use
  4. Mean family income in the US is $52,000.

cancer drug cost figureThe commentary references a study recently published in the Journal of Economic Perspectives that includes a chart that tells the inexplicable truth: the cost of drugs for each additional year of life gained has steadily increased over time. (Click on the figure at right.)  The good news is that newer drugs can prolong lifespan and improve the quality of life of cancer patients.  The bad news is that these drugs are rapidly becoming unaffordable to the average American.

In many instances, health care journalists don’t seem to be telling their readers about the rising cost of these drugs and what that trend means for patients. Consider the following new stories about cancer drugs that reviewers on this site rated Not Satisfactory on discussion of costs:

  • Reuters: Bristol-Myers immunotherapy combo promising in melanoma. Excerpt of our review: “The story doesn’t address cost at all, and it’s a glaring omission. Yervoy costs around $30,000 per injection — and the combined cost of treatment with the two drugs would likely cost a patient (or that patient’s insurance provider) more than a quarter of a million dollars.”
  • Bloomberg: Merck drug helps colon cancer patients with DNA repair defect Excerpt: “Despite the fact that Bloomberg Business delivers market and business news, there is no mention of cost in this article. Keytruda by Merck is thought of as a specialty medication, which means it is quite expensive. The drug has previously been estimated to cost $12,500 per month of treatment. Also, broad genetic testing to identify mismatch repair deficiencies that can be treated with this drug will not come cheap. There’s no mention of how much the test costs and whether it is covered by insurance.”

But there’s some indication that health care journalists just might be becoming more cost conscious. Last week, the Wall Street Journal focused attention on pricing for an experimental new Eli Lilly drug, necitumumab, which the authors of a JAMA Oncology pricing study said should cost no more than about $1745 per month, given its marginal average survival benefit of only 6 to 7 weeks. They noted that pricing for other similar new drugs typically exceeds $10,000 per month.

That’s an important proposal, and kudos to the Journal for covering it. Mentioning cost in any discussion of new cancer therapies is a critical step toward raising public awareness.

The Mayo Clinic Proceedings commentary also suggests the following actions that could be taken to address this issue:

  • Creating a post-FDA drug approval review mechanism to propose a fair price for new treatments, based on the value to patients and heath care
  • Allowing Medicare to negotiate drug prices
  • Allowing the Patient-Centered Outcomes Research Institute, created through the Affordable Care Act to evaluate the benefits of new treatments, to include drug prices in their assessments of the treatment value
  • Allowing importation of cancer drugs across borders for personal use (e.g., prices in Canada are about half of prices in the United States)
  • Passing legislation to prevent drug companies from delaying access to generic drugs (pay-for-delay)
  • Reforming the patent system to make it more difficult to prolong product exclusivity unnecessarily (patent “evergreening”)
  • Encouraging organizations that represent cancer specialists and patients (eg, American Society of Clinical Oncology, American Society of Hematology, American Association for Cancer Research, American Cancer Society, National Comprehensive Cancer Network) to consider the overall value of drugs and treatments in formulating treatment guidelines

Readers are encouraged to sign on to a petition posted at  The goal is one million signatures. At the moment approximately 30,000 people have signed on.

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Comments (1)

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Marc Beishon

September 8, 2015 at 4:15 am

The American Society of Clinical Oncology (ASCO) has also launched a framework for assessing the value of new cancer therapies “based on treatment benefits, toxicities and costs”. But does anyone think there will be significant change in the US given you political situation and fear of ‘rationing’? There has been one case where oncologists at Sloan refused to prescribe Zaltrap, a colon cancer drug that adds little benefit over previous therapy and the maker promptly dropped the cost from a stratospheric level, which may indicate a breaking point on the physician side.