Oncology is the therapeutic area in which the value challenge is most acute. According to 41% of survey respondents and 50% of those from drug companies, it is the most difficult area in which to demonstrate value.
A major part of the problem is the high cost of many new medications in this field which, "from the payer perspective, have somewhat limited clinical benefits in that they extend life by three or six months," says Dr Christopher-Paul Milne, associate director of the Tufts Centre for the Study of Drug Development at Tufts University in Boston, Massachusetts. This problem has been growing steadily: a 2009 study in the New England Journal of Medicine found that the median cost of cancer medication had increased more than 4.5 times in the preceding decade.[1] Payers understandably sometimes balk at the expense: in 2011 alone the National Institute for Health and Clinical Excellence (NICE) in the UK recommended that health authorities not reimburse for Bristol-Myers Squibb's Yervoy for late-stage metastatic melanoma and Sanofi's Jevtana for hormone refractory metastatic prostate cancer.
Value for money, however, is only part of the issue. Patricia Danzon, Professor of Health Care Management at the Wharton School of the University of Pennsylvania, explains that "there is a public perception that cancer is different, not necessarily from all other diseases, but from run-of-the-mill ones. That makes it harder to say 'no' [to new treatments], which gets people into a discussion of how much clinical benefit new treatments need to demonstrate to justify reimbursement. This is a tough choice, because paying more for cancer care means less spending on other things." The rejection of given treatments because of cost, however, opens up those who regulate formularies to accusations of passing death sentences.
Regulators are not unaffected by the higher value which societies seem to give to cancer treatments. Hervé Hoppenot, the president of Novartis Oncology, notes that "the acute nature of cancer for many patients – a disease that can kill them relatively quickly – makes the entire discussion with health authorities very different." He adds that many accelerated approvals by drug regulators are in oncology.
Nevertheless, those in charge of health budgets are caught in a bind. Science may provide a solution where cost-benefit analysis leaves only painful dilemmas, says Mr Hoppenot. "There is a significant technological revolution happening in the way we understand cancer," he explains that will help in gaining greater value from medications. The Economist Intelligence Unit article, "Cancer treatment and the search
for value", will look into how changing the way in which research on cancer is done can help with the value challenge in oncology.
[1] Peter B Bach, "Limits on Medicare's Ability to Control Rising Spending on Cancer Drugs". New England Journal of Medicine (2009); 360:626-633.
