The past 2 decades have seen a tremendous surge in expensive FDA-approved cancer drugs. As the cost of cancer care continues to rise, mounting emphasis will be placed on assessing the value of cancer treatment – that is, do the costs of new cancer drugs justify their benefits? A study by David H. Howard, PhD, Associate Professor, Department of Health Policy and Management, Emory University, Atlanta, and colleagues demonstrated that although anticancer drugs are associated with increased expenses, they were also accompanied by considerable survival benefits across different cancer types (Howard DH, et al. Health Aff [Millwood]. 2016;35:1581-1587). Analyzing data from more than 73,000 patients included in the SEER–Medicare database, which contains records from SEER tumor registries linked with Medicare claims, Dr Howard and colleagues examined the value of physician-administered intravenous drugs and oral drugs, in terms of lifetime medical costs versus life expectancy, in patients diagnosed with metastatic breast cancer, lung cancer, kidney cancer, or chronic myeloid leukemia (CML) from 1996 through 2000 and 2007 through 2011. Lifetime medical costs included the costs of drugs, outpatient visits, and hospital admissions from diagnosis until death. Of the 73,024 patients included in the study, 62,865 had lung cancer, reflecting “the high incidence of the disease and the high proportion of patients with lung cancer who are diagnosed with metastatic disease,” Dr Howard and colleagues reported. They also found an increase in the proportion of patients diagnosed with kidney cancer or with CML who received oral anticancer drugs between 2007 and 2011, which they attributed, in part, to the introduction of new oral anticancer drugs.
Study data showed that among patients with breast cancer who received physician-administered intravenous drugs, the average life expectancy and medical costs increased by 13.2 months and $72,200, respectively, versus 2 months and $8900, respectively, for patients who did not receive physician-administered intravenous drugs (Table). The life expectancy and medical costs for patients with lung cancer who received drugs increased by 3.9 months and $23,200, respectively, compared with 0.7 months and $4000, respectively, for patients who did not receive therapy. Unlike for breast and lung cancer, estimates of life expectancy and medical costs for patients with kidney cancer or CML were calculated as averages across patients who did and did not receive drug therapy, totaling 7.9 months and $44,700, respectively, for patients with kidney cancer, and 22.1 months and $142,200, respectively, for patients with CML (Table). The majority of patients with kidney cancer or CML in this analysis did not receive physician-administered intravenous drugs or oral anticancer drugs. In addition, the cost-effectiveness ratios equaled $114,000 for breast cancer, $124,900 for lung cancer, $144,800 for kidney cancer, and $145,900 for CML–all of which were near or below the majority of estimates of the value of a quality-adjusted life-year, the investigators explained.
“Increases in the cost of treating patients with metastatic breast, lung, or kidney tumors or CML were accompanied by meaningful improvements in survival,” Dr Howard and colleagues said. Although the researchers were unable to attribute these life expectancy increases to specific anticancer drugs, they elucidate that the increase most likely resulted from the use of newer drugs, because all of the patients had metastatic disease. “Our results highlight the importance of considering outcomes and overall costs in routine practice when assessing the value of anticancer drugs as a group,” added Dr Howard and colleagues. Prolonged life expectancy with the use of newer cancer drugs has important implications for future drug development endeavors, especially for cancers with poor survival rates, such as lung cancer. “In 2004 the FDA suggested that the incentives and opportunities to develop new drugs depended on public-sector investment in basic research, developments in translational medicine, and regulatory reforms that increase drug development. These opportunities and challenges persist for new anticancer drugs,” Dr Howard and colleagues stated.
