Value and Cancer Care: Toward an Equitable Future

Abstract

Health care expenses in the United States are increasing inexorably. At the current rate of growth, it is anticipated that 20% of the gross national product will consist of health-related expenditures within the next decade. Cancer is the second leading cause of death in the United States, and it is increasing in prevalence because of the aging of the population and the limited number of successful prevention strategies. As the biological characteristics of cancer come into sharper focus, targeted therapies are being developed that offer the promise of increased clinical benefit with fewer toxicities than are associated with conventional treatment. Although spectacular successes are infrequent with this approach, to date, the majority of targeted therapies are modestly effective at best, and extremely costly. This observation suggests that a broadly acceptable definition of value in a cancer therapeutic agent is not at hand, but is sorely needed from the vantage points of the patient and society. A corollary issue of enormous import is how to equitably distribute the health care dollar in the service of achieving the greatest good for the greatest number. Although cancer is responsible for only 5% of the health care budget, its cost is increasing and it can be viewed as paradigmatic when contemplating the problem of equity in health care. Here, a number of concepts are discussed that focus on this goal and its implications for the cancer patient and society at large.Clin Cancer Res; 16(24); 6004-8. Ó2010 AACR.Health care costs in the United States are increasing at a rate that exceeds overall economic growth. It is estimated that 20% of the gross national product will be allocated to health care in 2020. The burden to the economy as a whole is unambiguous and unsustainable. The burden to individuals affected by disease and their families is sometimes intolerable, leading to medical expenditures that precipitate declarations of personal bankruptcy. Cancer is the second most common cause of death in the United States, as well as an enormous cause of morbidity and psychological pain. Although not the primary driver of increasing US health care costs (cancer constitutes approximately 5% of the nation's health care costs; ref. 1), the costs of contemporary cancer care provide a model for understanding the problems and positing equitable solutions that might be incorporated into US health care. In order to provide a rational and ethical basis for arguing for constructive change, cancer can be viewed paradigmatically. In that context, its impact on society and the individual are explored, and societal considerations are addressed in the service of providing for more equitable allocations of the health care (cancer care) dollar. Principles of ValueThe burden on societyThe absolute number of dollars spent on cancer care during the periods between 1987 and 2001 to 2005 doubled, increasing from $24 billion to $48.1 billion per year. The basis for this doubling is the increased prevalence of the disease, probably as...

Evolution of costs of cancer drugs in a Portuguese hospital

“…In Europe, between 1998 and 2007, there was an important increase in direct costs related to cancer drugs [4,16,25] . The primary reasons for this were new indications for already approved drugs and the introduction of new drugs which cost significantly more than most of the older cancer drugs [4,6,7] .…”

“…In the past few years, direct costs related to cancer treatment have increased significantly [4,[12][13][14][15] . This increment in costs can be explained by the increase in cancer incidence, new indications for treatment with previously approved cancer drugs and to placement of new drugs on the market, which are frequently more expensive those already on sale [4,12,[16][17][18][19] . Despite the continuous growth in expenditure due to cancer drugs, this growth is not expected to be the same as in the last decade [4] .…”

Evaluating Patient-Centered Outcomes in the Randomized Controlled Trial and Beyond: Informing the Future with Lessons from the Past

“…These population-based outcome studies may provide insight into: uptake of new therapy, the impact of a change in practice and/or policy on outcomes, and the societal benefit of medical research. Furthermore, as discussed elsewhere in this CCR FOCUS series by Schnipper and colleagues, consideration of economic aspects of cancer care from a population perspective are urgently needed (51). Population-based studies also provide a mechanism to identify gaps in care following publication of a pivotal RCT and can facilitate targeted efforts in knowledge translation.…”

Semisynthetic Esters of 17-Hydroxycativic Acid with <i>in Vitro</i> Cytotoxic Activity against Leukemia Cell Lines

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