Cancer is the most dreaded of all diseases, the authors of a new study suggest, which may explain why policymakers have sometimes given cancer therapies preferential status over therapies for other conditions (Neumann PJ, et al. Health Aff [Millwood]. 2012;31:700-708). However, some oncologists and health economists believe that pharmacoeconomic evaluations and reimbursement decision makers should judge cancer interventions by the same standards as those used for all other medical conditions. This new study examined whether pharmacoeconomic analyses of therapies and biotechnologies, which help to inform payers in their coverage and reimbursement decisions, indeed give cancer interventions special treatment.
Using a literature search for world-wide organizations that singled out cancer for special attention, Dr Neumann and colleagues found that some countries have created special assessment pathways for reviewing cancer therapies. Others have made exceptions to ease access to cancer therapies through special policies, based on disease severity or end-of-life care, or have implemented accelerated review or enhanced-access procedures for oncology products.
In the United States, Medicare does not cover cancer and noncancer therapies at different rates, but cancer drugs receive special status by virtue of unique Medicare rules covering off-label indications. Between 1999 and 2010, Medicare covered more cancer-related diagnostic imaging and testing interventions (60%) than other interventions, such as medical devices (~19%), medications (~14%), or surgical procedures (~8%).
Access to cancer drugs is greater in the United States than in other countries. For example, 100% of all cancer drugs approved by the US Food and Drug Administration between 2004 and 2008 were covered by Medicare, most of them without restrictions or additional requirements. By contrast, the UK National Institute for Health and Clinical Excellence recommended coverage for <50% of the cancer drugs licensed by the European Medicines Agency.
Cancer is already the diagnosis associated with highest costs in terms of out-of-pocket medical expenses to patients, and as the costs of cancer therapies rise, policymakers wrestle with how to consider these costs. In the United Kingdom, Canada, and other countries, healthcare policymakers have sometimes made adjustments to cover cancer drugs, despite their poor cost-effectiveness.
The researchers suggest that in the United States, those involved in drug assessments are unlikely to use explicit cost-effectiveness considerations to determine the clinical value of cancer therapies. Rather, they are using strategies such as (1) personalized medicine and patient-centered care as a way to limit access to therapies to patients who are most likely to benefit from those treatments, (2) tie payment more directly to patient outcomes, and (3) allow access to important advances, while trying to control costs.
