What Happens when the Cost of Cancer Care Becomes Unsustainable?

Abstract

Cancer places a heavy burden on healthcare systems. The cost of cancer drugs is increasing, driven largely by the introduction of new, ever more innovative cancer treatments. This raises questions about value for money and the future sustainability of cancer care, and presents significant challenges for decision-makers in providing all patients with access to treatments and effective new cancer medicines. The aims of this article are to provide an understanding of how sustainability in cancer care is defined, what signs indicate that the limits of sustainability are being reached, and what potential impact this may have on patients with cancer within Europe. Each country is faced with making difficult decisions about the allocation of healthcare resources to cancer care, to best meet the health needs of their patients. Determining the value of individual cancer drugs can help to inform these decisions, because premium pricing for incremental innovation is no longer sustainable. When the cost of cancer care becomes unsustainable, countries may be forced to restrict health expenditure by limiting demand, cutting spending and reducing investment. This can lead to restricted access to treatment. New, innovative cancer treatments must provide greater value than current options, and measures are needed to contain and reduce expenditure and make best use of scarce resources, without impeding access to effective and safe treatments for all patients.

Can we Continue to Afford Access to Cancer Treatment?

“…Traditionally, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) have served as surrogate markers for value, although this approach fails to incorporate the viewpoints of all key stakeholders (i.e., patients, payers, providers, the public and policymakers). 55 The European Society of Medical Oncology (ESMO) and American Society of Clinical Oncology (ASCO) have developed tools to evaluate the clinical utility of oncology drugs and assess their relative value 56,57 (discussed further in the second paper in this series 13 ).…”

Potential Solutions for Sustaining the Costs of Cancer Drugs

“…17 Professional organisations, including the European Society of Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO), have taken the lead in assessing the real value of treatments by creating value frameworks for drug treatments, which vary in several dimensions. 5,20,21 However, there are major limitations to these frameworks, including the lack of a well-defined theoretical basis for determining value and the absence of analyses relating to how payers, physicians or patients would make decisions based on the available metrics. 19 One of the challenges in assessing treatment value is how to measure and compare health outcomes and costs.…”

“…how much an individual or society is willing to pay for an incremental health gain, could be used for the valuation of various dimensions of treatment. 5,19 However, allocative value (the distribution of assets among population subgroups), technical value (how well assets are used among those in need) and personalised value (how well decisions relate to individuals' values) should also be considered. 22 It is also important to understand that reducing overall costs may sometimes necessitate increasing spending for some services to enable a reduction in others.…”

“…The current situation and consequences of reaching the sustainability ceiling (where costs of treatment outweigh the benefits), including definitions of sustainability and value, are discussed further in the first and second articles in this series of three perspectives. 4,5 To regulate spending and allow continued -or even improved -access to cancer treatments, changes must be made before the sustainability ceiling is reached. 4,5 As detailed in the first two articles of this series, the continuing exponential rise in costs is driven, in part, by the introduction of a large number of new, high-cost treatments.…”

“…4,5 To regulate spending and allow continued -or even improved -access to cancer treatments, changes must be made before the sustainability ceiling is reached. 4,5 As detailed in the first two articles of this series, the continuing exponential rise in costs is driven, in part, by the introduction of a large number of new, high-cost treatments. Although innovation and research into new treatments should be encouraged, additional focus is needed on value-based medicine, characterised by evidence-based medicine, patient-centred care and cost-effectiveness.…”