Bringing down the cost of cancer treatment

Author(s): Elie Dolgin

The year 2011 was a watershed for cancer medicines in the United States. In the space of five months, federal regulators approved the first checkpoint-inhibitor immunotherapy, the first treatment for an aggressive form of thyroid cancer, the first personalized drug for the skin cancer melanoma, the first in an innovative class of targeted agents for lung cancer, and a 'weaponized' antibody therapy that delivers a drug to tumour cells in people with lymphoma.

The potency, complexity and innovative nature of these treatments were noteworthy. But so was the price. Each cost more than US$100,000 per person when taken for a year -- a rarity at the time for oncology drugs.

The prices seemed staggering to doctors, patients and health-care providers alike. But quickly, they became normal. By 2014, the average cost of a new orally administered cancer medicine exceeded $135,000 a year -- up to six times the cost of similar drugs approved in the early 2000s, after adjusting for inflation. 2017 brought the most eye-popping price tag in oncology yet: a one-time cost of $475,000 per patient for a personalized cell-based therapy for childhood leukaemia.

This generation of treatment promises to transform the field of cancer, yielding more cures and long-term remissions than ever before. But as medicine's ability to tackle tumours races ahead, health-care systems worldwide are struggling to deliver the benefits. If the affordability of drugs is not addressed soon, many people with cancer might not be able to reap the rewards of cutting-edge therapies. "We're on a trajectory that's really unsustainable," says Ameet Sarpatwari, an epidemiologist and legal scholar who studies drug pricing at Brigham and Women's Hospital in Boston, Massachusetts.

"It's really a major issue," says Sabine Vogler, a health economist at the Austrian Public Health Institute in Vienna. Drugs are unaffordable in many parts of the world. "We have to ask ourselves," she says, "how long can we continue paying these high prices?"

Strategies of containment

New drugs are not the only aspect of cancer care that is getting more expensive. The costs associated with doctors' salaries, diagnostic tests, radiotherapy and surgery are all rising, says Darius Lakdawalla, a health economist at the University of Southern California in Los Angeles. Collectively, they continue to make up the lion's share of cancer-care expenditure. "This is a systemic problem," he says.

And as Daniel Goldstein, an oncologist and health economist at the Rabin Medical Center in Petah Tikva, Israel, and his colleagues reported last year, even the cost of existing cancer drugs has been increasing precipitously -- well above the rate of inflation and much faster than other aspects of health care. This price creep, as Goldstein calls it, can cause harm to patients, with a large number of them delaying or skipping treatments that they can no longer afford. Health-care costs are then compounded, Sarpatwari says, because people who don't take their drugs as scheduled are more likely to require hospitalization at a later point. "If people can afford their drugs, it...