While cancer survival rates are improving, treatment costs continue to climb. Many of these costs can be attributed to pharmaceuticals or combinations of pharmaceuticals with high monthly price tags. But these medications may not even be serving their intended functions. Increasingly rapid FDA approvals and lack of follow-up testing are contributing to a growing concern that many critical treatments are ineffective at best— and at worst, detrimental or even toxic.
To speed-up new cancer medication approval, FDA personnel measure the effectiveness of many drugs based on surrogate end points — or measures that may but often don’t correlate to patient quality and length of life. When FDA approval is based on a surrogate end point, subsequent studies are advised and often obligated to clarify the drug’s effect on overall survival. However, a 2009 GAO report found only a 70% compliance rate for submission of these follow up studies. And in the cases where there are follow-up studies, many of these drugs have been found to be ineffective at lengthening or improving life. Still, many remain on the market at soaring costs. Some drugs that remain on the market have even been found to shorten life or cause side effects that are unbearable or even deadly — all with no proven benefits to patients.
The number of approved pharmaceuticals is rising, which means more and more of these drugs could enter the market. They could also pose potential health risks — and patients using them could incur a huge financial burden.
According to the Milwaukee Joual Sentinel article, monthly cancer treatment costs average around $10,000 but can be as high as $40,000. Generally speaking, the more effective the FDA proves the drug to be, the higher the price. According to the National Cancer Institute homepage, cancer care in the U.S. cost approximately $157 billion in 2010, but, with the aging population, the projected the cost for 2020 is $174 billion.
Costs vary by cancer site, severity, and drugs prescribed for treatment. According to the National Cancer Institute home page, costs are projected to rise for all stages of cancer care by 2020 compared to 2010 numbers, but the largest cost increase will likely be during the time during the initial diagnosis and the last phase of life. In every phase, though, costs are rising rapidly. Clinical trials and the increase in the use of combination therapies add to this challenge.
Effective treatment for the best patient outcomes and care quality involves treatment plans in which healthcare providers utilize evidence-based treatment, progress and benchmark oversight and measurement, risk-related site and service coordination, and case-specific strategies to manage care with regard to costs. When providers utilize this integrated approach and are mindful to only pay for covered costs, the savings can be enormous.
Contact the experts at PartnerRe PULSE + Plus™.
Articles on insurance “tech trends” often focus on specific technologies and the impacts that these will have on our industry, or indeed the world. Looking […]
Q1. What level of underwriting automation can reasonably be achieved in your target market? Why is this question important? A straight through processing (STP) rate […]