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Subject: qotd: U.S. cancer drug policy is scandalous
Date: Mon, 15 Apr 2013 10:57:58 -0700
From: Don McCanne <firstname.lastname@example.org>
To: Quote-of-the-Day <email@example.com>
Compared To US Practice, Evidence-Based Reviews In Europe Appear To Lead
To Lower Prices For Some Drugs
Joshua Cohen, Ashley Malins and Zainab Shahpurwala
In Europe drug reimbursement decisions often weigh how new drugs perform
relative to those already on the market and how cost-effective they are
relative to certain metrics. In the United States such
comparative-effectiveness and cost-effectiveness evidence is rarely
considered. Which approach allows patients greater access to drugs? In
2000–11 forty-one oncology drugs were approved for use in the United
States and thirty-one were approved in Europe. We compared patients'
access to the twenty-nine cancer drugs introduced into the health care
systems of the United States and four European countries (England and
Wales, France, Germany, and the Netherlands). Relative to the approach
used in the US Medicare program in particular, the European
evidence-based approach appears to have led to reduced prices for those
drugs deemed worthy of approval and reimbursement. The result is
improved affordability for payers and increased access for patients to
those drugs that were available. The United States lacks a systematic
approach to assessing such evidence in the coverage decision-making
process, which may prove inadequate for controlling costs, improving
outcomes, and reducing inequities in access to care.
From the Discussion
The current method in the US Medicare program of seemingly "muddling
through elegantly" appears incapable of striking a fiscally sustainable
balance between cost and access, particularly with respect to cancer
drugs. Spending on cancer treatments continues to grow at double-digit
rates annually, which in turn has led to much higher cost sharing for
patients. This has an impact on the kind of treatment that Medicare
beneficiaries get because patients with better insurance, or those who
are able to pay higher out-of-pocket costs, have better access to care.
Medicare policy makers might do well to draw lessons cautiously from the
experiences of health care systems that have integrated clinical and
economic evaluations into decision making. Should the US Medicare
program decide to move toward more systematic use of comparative
effectiveness findings, there are formidable challenges inherent in the
US system that will need to be addressed.
One challenge is payer fragmentation. The diffuse system of payers would
probably make the uptake of comparative effectiveness evidence segmented
A second challenge is the view of many oncologists that resources are
unlimited. In a US-based survey conducted in 2009, nearly 80 percent of
oncologist respondents said that patients should have access to
"effective" care regardless of costs. An implied cost-effectiveness
threshold was calculated at $300,000 per quality-adjusted life-year.
Needless to say, having Medicare pay for every cancer treatment that
cost up to that amount would not be feasible in the long run.
There is room in the US Medicare program for more systematic and
coordinated methods and a process for developing and implementing
evidence relative to cost and cost-effectiveness. The immediate goal
should be to encourage a more evidence-based process of decision making
by closing the gap between what providers, payers, and policy makers
know in pharmaceutical care and what they do.
Comment: Cancer drug policies in the United States, compared to other
nations, result in higher drug costs, intolerable out-of-pocket costs,
and inequitable access to the drugs - preventing many people from
receiving comparatively effective drugs, while enabling others to have
very expensive drugs of little or no value, wasting our healthcare dollars.
We can do far better in establishing drug policies that are
evidence-based and cost-effective based on quality-adjusted life-years.
First we need to elect leaders who care more about us, as patients, than
they care about kowtowing to the pharmaceutical giants and other special
When it comes down to it, it really is our fault when we fall for the
government-can't-do-anything-right malarkey, and elect those who
disseminate this false notion.