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Hard questions about chemo

Rating

4 Star

Hard questions about chemo

Our Review Summary

This is an important piece about a major problem in healthcare costs in the U.S.  Even for people with life-threatening illness (that is not acute, and treated as an inpatient), care is not guaranteed for those who cannot pay.  There is enough variation in costs of potential treatment regimens that the practice of informing patients about cost with treatment options should be encouraged.  Although distressing, launching a family into financial disaster is an adverse outcome as well.

This particular story focuses on the increasing cost of 2nd or 3rd-line chemotherapy drugs aimed at advanced cancer.  The story notes that patients are often forced to choose between these treatments and their financial savings.  The story explains that because the market for  certain drugs is small and focused, the cost of these chemotherapy drugs is higher.  The story appropriately notes that cost should be discussed as an additional side effect of treatment.

The story notes via an American Cancer Society rep that it "costs a billion dollars" to bring a drugs to market; however, we are not told of the typical profit made from these drugs once they are available to patients.  This is an oversight in reporting about cost. There is also considerable debate about the validity of that claim about pharma’s R&D costs – which the story does not address. The story does not discuss how these newer drugs work, or how much quantity and quality of life they add to patients’ lives.  The story does not discuss if newer drugs are any better than older drugs for treating cancer. We are told that some newer drugs have fewer or different side effects.

The story provides information on alternative older drugs that may be an option for cancer treatment.  The story also provides some resources for patients who may qualify for free or reduced-cost medicines.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story focus is the increased cost of 2nd or 3rd-line chemotherapy drugs aimed at advanced cancer.  The story notes that patients are often forced to choose between these treatments and their financial savings. The story appropriately notes that cost should be discussed as an additional side effect of treatment. The story notes via an American Cancer Society rep that it "costs a billion dollars" to bring a drug to market; however, we are not told of the typical profit made from these drugs once they are available to patients.  A terrific book by Merrill Goozner, "The $800 Million Pill," also pokes holes in the claim of that much in drug R&D. This is an oversight in reporting about cost.  Nonetheless, we’ll give the story the benefit of the doubt.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story only discussed costs and side effects.  Why were data on benefits left out?   The story does not discuss how these newer drugs work or how much quantity and quality they add to patients’ lives.  The story does not discuss if newer drugs add months or years to patients lives and if they are any better than older drugs for treating cancer. We are told that some drugs have fewer or different side effects.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story discusses the side effects of certain chemotherapy drugs. While the story is about chemotherapy in general, there was a nice example near the end about a newer regimen that is far more expensive but associated with fewer side effects. The story focuses on the burden of cost, which oncologists have begun to consider with patients as another downside or side effect of chemotherapy regimens.  The story notes that there are now guidelines for discussing and planning for the cost of treatment with patients.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story focuses on cost of cancer treatments and provides price estimates for certain chemotherapy drugs. The story does not do a good job explaining how these drugs  treat cancer or extend a patient’s life. The story notes that patients should weigh the benefits of these drugs, but they do not explicitly discuss what this means.  The story provides some qualitiative evidence via family stories that these drugs are cost-prohibitive for many patients. It is not necessarily helpful to discuss costs without discussing benefits in absolute terms.  The story didn’t give us that evidence.

Does the story commit disease-mongering?

Satisfactory

Cancer is of course a prevalent disease; this piece did not hype that fact. The story discusses the small number of people who would be eligible for newly approved and/or experimental drugs to treat advanced cancer.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes perspectives from families, patients and oncologists who discuss weighing the benefits of newer chemotherapy drugs with the increased cost. It would have been useful to interview a pharmaceutical manufacturer for a quote on the typical profit of chemotherapy drugs  after recouping money for the development of these drugs. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story provides information on alternative older drugs that may be an option for cancer treatment. The story notes that the tradeoff may be the type of side effects. The story also provides some resources for patients who may qualify for free or reduced-cost medicines. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story focuses on newer chemotherapy regimens that may be unavailable to some people as they are too expensive.  The story explains that because the market for chemo certain drugs is small and focused, the cost of the drugs is higher. The story also notes that some patients may qualify for need-based help via hospital and drug-company sponsored assistance.

Does the story establish the true novelty of the approach?

Satisfactory

The story discusses newer chemotherapy drugs and the consistent increase in cost–about 15 percent a year. 

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story contains a great deal of independent reporting and information does not appear to be taken from a press release.

Total Score: 8 of 10 Satisfactory

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