Targeted cancer therapies work. Two-thirds of all US cancer patients, most of them taking intravenous or oral targeted drugs, survive at least 5 years after diagnosis. But this comes at a cost. Such therapies “now dominate anticancer drug spending,” according to a new study, published on May 18, 2015 as an Early Release article in the Journal of Clinical Oncology.
In 2011, targeted therapies accounted for 63 percent of all chemotherapy expenditures in the United States. In the ten years from 2001 to 2011, insurance payments per patient in the first year of treatment increased by more than $14,000. Out of pocket spending for cancer drugs steadily rose, to about $200 per patient per month for oral drugs and to $900 per month for targeted intravenous anti-cancer therapy. Total annual insurance payments, by 2010, reached around $65,000 per patient.
“Because of how insurance works, we found huge differences in costs based solely on whether chemotherapy is swallowed as a pill or infused into a vein,” said Fabrice Smieliauskas, PhD, assistant professor in the Department of Public Health Sciences at the University of Chicago. “With so many new drugs available for breast, prostate, and other cancers, patients and oncologists have the benefit and the burden of choice, and should be prepared to discuss how costs might figure into their preferred treatment approach.”
The research team—from the University of Chicago Comprehensive Cancer Center, the University of Texas M.D. Anderson Cancer Center, Fox Chase Cancer Center, and the Sidney Kimmel Cancer Center at Johns Hopkins University—focused on nonelderly cancer patients with private insurance. Average age was 52. They gathered data on more than 200,000 patients who were treated between Jan. 1, 2001, and Sept. 30, 2011.
The use of targeted therapies grew steadily over this period, from about 13 percent in 2001 to 43 percent in 2011. Costs increased almost as rapidly, from 22 percent of cancer spending for this group of patients in 2001, to 63 percent in 2011.
Cost per patient, however, changed little for targeted intravenous drugs, holding steady at around $7,000 per patient per month, or $65,000 per year.
For targeted oral drugs, however, prices went up consistently, more than doubling from about $3,400 per patient per month in 2001 to almost $7,400 in 2011.
“Our findings pinpoint rising costs of targeted oral anticancer medicines in particular as a major source of the rising costs of anticancer drugs,” the authors wrote. Payers and specialty pharmacies “have been reluctant to manage costs of targeted oral anticancer medicines to any degree, largely because of opposition from patients with cancer and oncologists.”
In summary, they add, “the shift toward treatment with targeted therapies and price inflation at all stages of the drug lifecycle documented in our study highlight the need for creative use of value-based managed care tools by private payers to curb the escalating cost of anticancer drugs.”