Examining Cost and Benefit: Quality Care in Cancer is Not Only a Matter of Proper Medication

The European Society of Medical Oncology, ESMO, the leading professional organization for medical oncology with over 18,000 members representing oncology professionals from over 150 countries worldwide, this week, shared concerns expressed in a scientific paper discussing the rising costs of cancer medicines.[1]

The purpose of the study was to determine if clinical benefits of novel anticancer drugs, measured by the American Society of Clinical Oncology‘s (ASCO) Value Framework and European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS), have increased over time in parallel with increasing costs.

The study was published in The Journal of Oncology Practice, a journal of the American Society of Clinical Oncology.

In their study, the authors concluded that while costs of novel anti-cancer drugs have risen over the past decade, the clinical benefit has not improved proportionally.They also observed that the incremental anticancer drug costs have increased at a much greater rate than monthly prices, indicating that the increase in anticancer drug costs may be higher than commonly reported.[1]

Study design
The authors identified novel anti-cancer agents included in phase III randomized controlled trials cited for clinical efficacy evidence in drug approvals. Using the ASCO and ESMO frameworks, they specifically looked at novel drugs and drug approvals between January 2006 to December 2015. Then, for each drug, they calculated the monthly price and incremental anticancer drug costs. Using generalized linear regressions models, the authors then examined the relationships between cost and year of approval. To evaluate the relationship between the ASCO and ESMO frameworks and year of approval, the authors used ordinary least square models. Spearman correlation coefficients between costs and clinical benefit scores were also calculated.[1]

The authors included 42 randomized controlled trials in their study. They noted that monthly prices and incremental anticancer drug costs were significantly associated with year of approval. They also noted an average annual increase of 9% and 21%, respectively.

The predicted mean incremental anticancer drug cost increased more than five-fold. In real money, the increase shown was from US $ 30,447.00 in 2006 to US $ 161,141.00 in 2015. However, the ASCO Value Framework and ESMO Benefit Scale were not statistically associated with year of approval or correlated with monthly prices or incremental anticancer drug costs.

Unbiased information
The ESMO-MCBS uses a rational, structured and consistent approach to grade the magnitude of clinical benefit that can be expected from anticancer treatments.

?The ESMO-MCBS provides unbiased information to help guide physicians and decision makers to grade drugs newly approved by the European Medicines Agency (EMA) by assessing their clinical benefit. It is an important first step in the major and ongoing task of evaluating value in cancer care which is essential for the appropriate use of limited public funds in delivering cost-effective and more affordable cancer care,? said Professor Elisabeth de Vries, Chair of the ESMO Cancer Medicines Committee and the ESMO-MCBS Working Group.

?Access to anticancer medicines is an essential component of high quality cancer care, hence affordability is crucial in providing optimal treatment and patient care,? noted professor Josep Tabernero, ESMO President.

There are however many additional critical factors.

?Other major considerations include the availability of highly trained oncologists, up-to-the-minute diagnostics, the necessary funding and frameworks in place for research, a holistic approach to cancer care incorporating supportive and palliative care, and a multidisciplinary approach to best manage and treat our patients,? Tabernero continued.

?ESMO calls for a multi-stakeholder commitment towards ultimately ensuring access to optimal cancer care for all patients,? he added .

?Sustainable cancer care is a key pillar of the ESMO 2020 Vision and we are determined to continue pursuing this goal in collaboration with our partners,? Tabernero concluded.

References
[1] Saluja R, Arciero VS, Cheng S, McDonald E, Wong WWL, Cheung MC, Chan KKW. Examining Trends in Cost and Clinical Benefit of Novel Anticancer Drugs Over Time. J Oncol Pract. 2018 May;14(5):e280-e294. doi: 10.1200/JOP.17.00058. Epub 2018 Mar 30.


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