Managing Editor’s Memo

How Much Can We Really Afford To Go All Out To Treat Cancer?

Frank Diamond

It’s not a boxing opponent. But the metaphor of “the fight” clings more closely to cancer than to other diseases. And while attitude does, indeed, count when it comes to handling any ailment, positive and optimistic people die from cancer every day. Meanwhile, some grumps go on.

It’s a disease. Cancer eats its deadly way through a person’s life and how it progresses or doesn’t progress isn’t much tied to the patient’s attitude. (Attitude plays the part in cancer that it plays in every other setback and disaster we face: How do we cope with affliction?)

And how do you cope with the cost of groundbreaking treatments that offer hope to patients and headaches for insurers? Lee Newcomer, MD, a former senior vice president at UnitedHealthcare puts it succinctly in our cover story: “We have a limited set of dollars.”

Take CAR-T therapies, for example. Our story shows just how financially perplexing this can get. The $475,000 one-time cost of Kymriah exceeds the cost for conventional chemotherapy by almost $330,000. It would also provide a child with about eight extra years of life on average. Who’s going to say “no?”

Few would argue that these new treatments are not worth it because cancer death rates overall are declining. But not for one of the more deadly kinds, liver cancer, as our story on page 29 reports.

One way of dealing with price concerns is through indication-specific drug pricing. As our story indicates, the idea is gaining steam, and an IMS report states that by 2020 most new oncology drugs will have three or more indications.

Does anyone have any solution about balancing cost, outcomes, and human decency?


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