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Evidence-Based Oncology The American Society of Hematology Annual Meeting, 2014
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Healthcare Costs in Need of Solutions: Experts at ASH Agree

Surabhi-Dangi Garimella, PhD
As medical oncologists, drug developers, and research scientists presented findings and novel treatment options in hematological cancers, a special session on the first day of the 56th Annual Meeting of the American Society of Hematology (ASH), held December 6-9, 2014, in San Francisco, addressed an aspect of cancer care that’s increasingly finding its way onto the agenda at clinical meetings, as was witnessed at the annual meeting of the American Society of Clinical Oncology (ASCO).1

The session, “The Rising Cost of Medical Care: Understanding the Problem and Exploring Solutions,” drew participation from hematologists and a representative from a company that provides market access support to the pharmaceutical industry. These experts came together on a common platform to discuss ways to tame the unsustainable healthcare expenditure in the United States, which touched $3.8 trillion in 2013.2

Escalating drug costs can influence patient adherence, quality of life, and overall health—an endless loop. Participants in this energetic discussion provided insight into these existing challenges and ways to address them. Kicking off the session was Hagop M. Kantarjian, MD, professor, Department of Leukemia, the University of Texas MD Anderson Cancer Center in Houston, Texas. Kantarjian presented strong views on the way the pharmaceutical industry sets drug prices during his talk, “Cancer Drug Prices in the US: Causes, Consequences and Solutions.” He said he is surprised by the high drug prices today, the triggers for him being the prices for 3 commonly used drugs for chronic myelogenous leukemia (CML): ponabinostat, bosutinib, and omacetaxine.  Each of the 3 drugs costs more than $100,000 per year. While cancer drug prices have been rapidly rising—a 10-fold increase over the past decade—the average household income, he said, has decreased by 8%. Kantarjian asked the audience to come up with solutions to help these patients who might be victimized in the process. High out-of-pocket costs, he said, are leading patients to personal bankruptcy, adherence issues, and mental stress; results show that 10% of patients abandon treatment and 20% have poor compliance. 

Kantarjian came down hard on the pharmaceutical industry for overestimating the amount spent on developing a drug. “The billion-dollar price tag per drug does not account for the 50% tax subsidy that they avail, and it’s the mean cost, not median,” he said. Kantarjian concluded his talk by providing several solutions to this growing problem: • increased/continued participation by organizations like ASCO and ASH in the discussion • allowing Medicare to negotiate the price of drugs they buy from the pharmaceutical manufacturers • allowing importing of drugs • preventing “pay-for-delay,” which blocks all other generic drug competition for a growing number of branded drugs.

Providing a nearly opposite opinion was Alex W. Bastian, MBA, vice president, market access, GfK Bridgehead. During his talk, “Hematology Drug Pricing in America: Moving to a Sustainable Model,” Bastian acknowledged that while the unsustainable drug costs cannot be ignored, the healthcare community must focus its attention on value of therapy rather than cost, which echoed the ASCO initiative. Bastian went on to emphasize, however, that the United States is not alone in this problem; rising healthcare costs are a global phenomenon. 

He presented the real-world situation: with the success of innovation and research, dramatic survival gains have been achieved in hematology over the past half century. However, an examination of the statistics reveals that while FDA-approved drugs have steadily increased between 1998 and 2014, 249 hematology drugs have failed during the same period. These failures, according to Bastian, need to be accounted for.

He reiterated the importance of identifying the value of therapy. “We need a long-term view of the situation, taking into consideration the total benefits that a drug might yield,” which can reduce the downstream cost of care.

S. Yousuf Zafar, MD, MHS, associate professor of medicine at Duke University, was the next member of the panel to share his thoughts. Zafar, a medical oncologist by training, is a health service researcher with an interest in improving care delivery for advanced cancer patients. His research focus includes studying the impact of cost of cancer care on patient preferences with cost-related communication and decision-making.3

During his presentation, Zafar alluded to the substantial financial burden of the high cost of care on cancer patients and survivors, which can impair their quality of life and diminish the quality of their care. He said that coupled with chemotherapy side effects, cancer treatment can be financially toxic. A study from Fred Hutchison Cancer Center published last year reported that people diagnosed with cancer are more than 2.5 times more likely to declare bankruptcy than those without cancer.4

Zafar 
to the fact that financial toxicity can also impact quality of care, as it puts patients at risk for cost-related nonadherence with their anticancer therapy; studies have demonstrated decreased adherence to tyrosine kinase inhibitors in patients with chronic myeloid leukemia, he said. Zafar used a case study of a patient in his clinic. He made a case that his patient lacked prescription drug benefits through his employer, which resulted in him refusing advanced therapy when his cancer metastasized. The patient told Zafar that he simply could not afford to pay for the treatment. Using this paradigm, Zafar suggested that physicians, patients, and policy makers face a growing mandate to integrate costs into clinical decision making. 

 
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