Bending the Cost Curve in Cancer Care

Smith, Thomas J.; Hillner, Bruce E.

doi:10.1056/nejmsb1013826

Cited by 363 publications

(267 citation statements)

References 57 publications

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“…The price of therapies to treat cancer has been on an exponential rise over the past decade [32]. Of the 12 agents used in cancer care that were approved in 2012, at least nine of them were priced at over $100,000 annually [33].…”

Section: Costmentioning

confidence: 99%

Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management

2014

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Disease overview: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm with an incidence of 1–2 cases per 100,000 adults, and accounts for ∼15% of newly diagnosed cases of leukemia in adults. Diagnosis: CML is characterized by a balanced genetic translocation, t(9;22)(q34;q11.2), involving a fusion of the Abelson oncogene (ABL) from chromosome 9q34 with the breakpoint cluster region (BCR) gene on chromosome 22q11.2. This rearrangement is known as the Philadelphia chromosome. The molecular consequence of this translocation is the generation of a BCR‐ABL fusion oncogene, which in turn translates into a Bcr‐Abl oncoprotein. Frontline therapy: Three tyrosine kinase inhibitors (TKIs), imatinib, nilotinib, and dasatinib have been approved by the US Food and Drug Administration for the first‐line treatment of patients with newly diagnosed CML in chronic phase (CML‐CP). Clinical trials with second generation TKIs reported significantly deeper and faster responses; their impact on long‐term survival remains to be determined. Salvage therapy: For patients who fail frontline therapy, second‐line options include second and third generation TKIs. Although second and third generation TKIs are potent and specific BCR‐ABL TKIs, they exhibit unique pharmacological profiles and response patterns relative to different patient characteristics, such as patients comorbidities, disease stage, and BCR‐ABL mutational status. Patients who develop the T315I “gatekeeper” mutation display resistance to all currently available TKIs except ponatinib. Allogeneic transplantation remains an important therapeutic option for CML‐CP who have failed at least 2 TKIs, and for all patients in advanced phase disease. Am. J. Hematol. 89:547–556, 2014. © 2014 Wiley Periodicals, Inc.

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Section: Costmentioning

confidence: 99%

Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management

2014

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“…50 In the United States, some leading oncologists have called for open discussions of cost-effectiveness with the appearance of new drugs with extraordinary costs and only modest benefits. 42,[51][52][53] Despite these developments, there is longstanding resistance to any form of explicit rationing of health care in the United States. Thus, it remains unlikely that US health technology assessment organizations will add cost-effectiveness criteria to their evaluations.…”

Section: Value Of Cancer Spendingmentioning

confidence: 99%

“…In other words, evidence reviews will provide context for physician and patient discussions about treatment options; trade-offs among risk, benefit, and cost; and patient preferences, such as whether to seek treatment or to shift goals to palliation or hospice care. 53,55 Along these lines, the American Society of Clinical Oncology has highlighted the importance of candid patient-physician discussions about cost considerations. 55 Linking Evidence To Payment For Cancer Therapies Finally, policy makers recognize that health technology assessment can be a blunt tool.…”

Section: Value Of Cancer Spendingmentioning

confidence: 99%

Therapies For Advanced CancersPose A Special Challenge For Health Technology Assessment Organizations In Many Countries

Neumann

Bliss²,

Chambers³

2012

Health Affairs

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“…Although the importance of following patients with sarcoma is widely accepted, frequent surveillance is time-consuming for both patients and physicians, increases healthcare expenditures [11,21,22], and, with respect to the use of CT scans, exposes patients to ionizing radiation [4]. Furthermore, limited evidence exists to support the intervals, modalities, or duration of monitoring [3,9,11].…”

Section: Introductionmentioning

confidence: 99%

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The potential for local recurrence and pulmonary metastasis after treatment of primary bone sarcomas necessitates careful patient followup; however, minimal data exist regarding the incidence and timing of these events, and therefore an evidence-based surveillance protocol has not been developed. Questions/purposes The purposes of this study were to (1) describe the frequency and timing of local recurrence by histologic grade over time; (2) describe the frequency and timing of metastasis by histologic grade and diagnosis over time; and (3) use these data to either justify current surveillance schedules and/or propose modifications that may improve the rate of new pulmonary metastatic events detected per examination. Methods A retrospective review was performed of all patients who underwent resection of a primary, nonmetastatic bone sarcoma (excluding chordoma) at a single tertiary oncology center from 1989 to 2010. Of the 680 patients identified, 15 were excluded for loss of followup in the first 2 years, leaving 665 eligible for study. Of these, 437 patients were alive with no evidence of disease at the conclusion of the study (mean followup, 136 months; range, 25-321 months). Cox regression analysis was performed to evaluate and control for patient age, tumor size, tumor location, and surgical margins. With patients stratified by sarcoma grade, Kaplan-Meier survival curves were constructed for the endpoints of local recurrence and metastasis, and log-rank tests were used to compare the rates of these events between grades and diagnoses. The number of new pulmonary metastatic events per patientyear was calculated for each sarcoma grade over the time intervals used in current surveillance protocols (0-2, 2-5, 5-10, and [ 10 years) to facilitate development of a surveillance schedule that would maximize events detected per imaging study performed. In addition, to determine the effect of disease type, subset analysis was performed for osteosarcoma (OSA) and chondrosarcoma because these were the only diagnoses with sufficient numbers to support individual statistical analysis. Results With the numbers available for study, the overall local recurrence-free survival did not differ between sarcoma grades at any time points (p = 0.864). Metastasis-free survival curves differed between sarcoma grades (p \ 0.001), and the pattern of Grade 2 OSA metastasis was more consistent with other Grade 3 sarcomas, so it was

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Bending the Cost Curve in Cancer Care

Cited by 363 publications

References 57 publications

Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management

Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management

Therapies For Advanced CancersPose A Special Challenge For Health Technology Assessment Organizations In Many Countries

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

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