Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-09T05:37:14.824Z Has data issue: false hasContentIssue false
  • English
  • Français

Valuing end-of-life care in the United States: the case of new cancer drugs

Published online by Cambridge University Press:  19 October 2012

Corinna Sorenson
Corinna Sorenson*
Affiliation:
Research Fellow in Health Policy, London School of Economics and Political Science, LSE Health, London, UK
*
*Correspondence to: Corinna Sorenson, London School of Economics and Political Science, LSE Health, Cowdray House, Houghton Street, London WC2A 2AE, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

New cancer therapies offer the hope of improved diagnosis to patients with life-threatening disease. Over the past 5–10 years, a number of specialty drugs have entered clinical practice to provide better systemic therapy for advanced cancers that respond to few therapeutic alternatives. To date, however, such advances have been only modestly effective in extending life and come with a high price tag, raising questions about their value for money, patient access and implications for health care costs. This article explores some of the key issues present in valuing end-of-life care in the United States in the case of advanced cancer drugs, from the difficult trade-offs between their limited health benefits and high costs to the technical, political and social challenges in assessing their value and applying such evidence to inform policy and practice. A number of initial steps are discussed that could be pursued to improve the value of advanced cancer care.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 4 , October 2012 , pp. 411 - 430
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abernethy, A. P., Raman, G., Balk, E. M., Hammond, J. M., Orlando, L. A., Wheeler, J. L., Lau, J.McCrory, D. C. (2009), ‘Systematic review: reliability of compendia methods for off-label oncology indications’, Annals of Internal Medicine, 150: 336–343.Google Scholar
Alexander, G. C., Casalino, L. P.Meltzer, D. O. (2003), ‘Patient–physician communication about out-of-pocket costs’, Journal of the American Medical Association, 290(7): 953–958.Google Scholar
American Cancer Society (2010), Cancer Facts & Figures 2010, Atlanta: American Cancer Society.Google Scholar
Ancker, J. S.Kaufman, D. (2007), ‘Rethinking health numeracy: a multidisciplinary literature review’, Journal of the American Medical Informatics Association, 14: 713–721.Google Scholar
Bach, P. B. (2009), ‘Limits on Medicare's ability to control rising spending on cancer drugs’, New England Journal of Medicine, 360(6): 626–633.Google Scholar
Barnato, A. E., Herdon, M. B., Anthony, D. L., Gallagher, P. M., Skinner, J. S., Bynum, J. P. W.Fisher, E. S. (2007), ‘Are regional variations in end-of-life care intensity explained by patient preferences? A study of the US Medicare Population’, Medical Care, 45(5): 386–393.Google Scholar
Becker, G. S., Philipson, T. J., Soares, R. R. (2007), The Value of Life Near Its End and Terminal Care, National Bureau of Economic Research Working Paper 1333, Cambridge, MA: NBER.Google Scholar
Berenson, A. (2005), ‘Cancer drugs offer hope, but at a huge expense’, New York Times, July 12.Google Scholar
Burns, J. (2011), ‘UnitedHealthcare's bold effort to deal with cancer drug costs’, Managed Care Magazine, January 2011.Google Scholar
Callahan, D. (2009), Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System, Princeton and Oxford: Princeton University Press.Google Scholar
Centers for Disease Control and Prevention (CDC) (2010), National Vital Statistics Reports, Vol. 58, No. 19, May 20. Atlanta: CDC.Google Scholar
Chalkidou, K. (2012), ‘Evidence and values: paying for end of life drugs in the British NHS’, Health Economics, Policy and Law.Google Scholar
Cohen, J.Looney, W. (2010), ‘What is the value of oncology medicines?’, Nature Biotechnology, 28: 1160–1163.Google Scholar
Danzon, P. M.Taylor, E. (2010), ‘Drug pricing and value in oncology’, Oncologist, 15(Supplement 1): 24–31.Google Scholar
Department of Health (2010), Equity and Excellence: Liberating the NHS, London: The Stationery Office Limited.Google Scholar
de Souza, J. A., Ratain, M. J.Fendrick, A. M. (2012), ‘Value-based insurance design: aligning incentives, benefits, and evidence in oncology’, Journal of the National Comprehensive Cancer Network, 10(1): 18–23.Google Scholar
DoBias, M. (2011), ‘No death panels, please, but poll shows Americans can handle end-of-life chat’, National Journal, March 8.Google Scholar
Drummond, M.Towse, A. (2012), ‘Is it time to consider the role of patient co-payments for pharmaceuticals in Europe?’, European Journal of Health Economics, 13(1): 1–5.Google Scholar
Earle, C. C., Landrum, M. B., Souza, J. M., Neville, B. A., Weeks, J. C.Ayanian, J. Z. (2008), ‘Aggressiveness of cancer near the end of life: is it a quality of care issue?’, Journal of Clinical Oncology, 26: 3860–3866.Google Scholar
Epstein, S. S. (2005), Cancer-Gate: How to Win the Losing War on Cancer, Amityville, NY: Baywood.Google Scholar
Faden, R. R., Chalkidou, K., Appleby, J., Waters, H. R.Leider, J. (2009), ‘Expensive cancer drugs: a comparison between the United States and the United Kingdom’, Milbank Q, 87: 789–819.Google Scholar
Faguet, G. B. (2005), The War on Cancer: An Anatomy of Failure, A Blueprint for the Future, Dordrecht, the Netherlands: Springer.Google Scholar
Fojo, T.Grady, C. (2009), ‘How much is life worth: Cetuximab, non-small cell lung cancer, and the $440 billion question’, Journal of National Cancer Institute, 101: 1044–1048.Google Scholar
Freemantle, N.Drummond, M. F. (2010), ‘AHRQ Series Commentary 3: The United States addresses comparative effectiveness but not cost-effectiveness through the Effective Health-Care Program’, Journal of Clinical Epidemiology, 63: 479–480.Google Scholar
Garau, M., Shah, K. K., Mason, A. R., Wang, Q., Towse, A., Drummond, M. F. (2010), Using QALYs in Cancer: A Review of the Methodological Limitations, Office of Health Economics, Research Paper 10/01, October 2010, London: OHE.Google Scholar
Garber, A. M.Sox, H. C. (2010), ‘The role of costs in comparative effectiveness research’, Health Affairs, 29(10): 1805–1811.Google Scholar
Gatyas, G., Longwell, L. (2008), ‘IMS Health reports U.S. prescription sales grew 3.8 percent in 2007, to $286.5 billion’. Press release, March 12. Norwalk, CT: IMS Health.Google Scholar
Gawande, A. (2010), ‘Letting go: what should medicine do when it can't save your life?’, The New Yorker, August 2.Google Scholar
Gerber, A. S., Patashnik, E. M., Doherty, D.Cowling, C. (2010), ‘The public wants information, not broad mandates, from comparative effectiveness research’, Health Affairs, 29(10): 1872–1881.Google Scholar
Giezen, T. J., Mantel-Teeuwisse, A. K., Straus, S., Schellekens, H., Leufkens, H.Egberts, A. C. G. (2008), ‘Safety-related regulatory actions for biologicals approved in the United States and the European Union’, Journal of the American Medical Association, 300(16): 1887–1896.Google Scholar
Goodman, D. (2011), ‘End-of-life cancer care in Ontario and the United States: quality by accident or quality by design?’, Journal of the National Cancer Institute, 103(11): 1–2.Google Scholar
Goldman, D. P., Jena, A. B., Lakdawalla, D. N., Malin, J. L., Malkin, J. D.Sun, E. (2010), ‘The value of specialty oncology drugs’, Health Services Research, 45(1): 115–132.Google Scholar
Goodman, D. C., Fisher, E. S., Chang, C., Morden, N. E., Jacobson, J. O., Murray, K.Miesfeldt, S. (2010), Quality of End-of-Life Cancer Care for Medicare Beneficiaries: Regional and Hospital-Specific Analyses, A Report of the Dartmouth Atlas Project, November, Lebanon, NH: Dartmouth Institute.Google Scholar
Goodman, D. C., Fisher, E. S., Chang, C., Morden, N. E., Jacobson, J. O., Murray, K.Miesfeldt, S. (2011), Quality of End-of-Life Cancer Care for Medicare Beneficiaries: Regional and Hospital-Specific Analyses, A Report of the Dartmouth Atlas Project, November, Lebanon, NH: Dartmouth Institute.Google Scholar
Gusmano, M. K.Gray, B. H. (2010), Evidence and Fear: Navigating the Politics of Evidence Based Medicine, AcademyHealth Reports, June, Washington, DC: AcademyHealth.Google Scholar
Harrington, S. E.Smith, T. J. (2008), ‘The role of chemotherapy at the end of life: “when is enough, enough”?’, Journal of the American Medical Association, 299: 2667–2678.Google Scholar
Hecht, J. R., Mitchell, E., Chidiac, T., Scroggin, C., Hagenstad, C., Spigel, D., Marshall, J., Cohn, A., Stella, P., Deeter, R., Shahlin, S.Amado, R. G. (2009), ‘A randomized phase IIIB trial of chemotherapy, bevacizumab, and panitumumab compared with chemotherapy and bevacizumab alone for metastatic colorectal cancer’, Journal of Clinical Oncology, 27(5): 672–680.Google Scholar
Himmelstein, D. U., Thorne, D., Warren, E.Woolhandler, S. (2009), ‘Medical bankruptcy in the United States, 2007: results of a national study’, American Journal of Medicine, 122: 741–746.Google Scholar
Hollingsworth, J. M., Zhang, Y., Krein, S. L., Ye, Z.Hollenbeck, B. K. (2010), ‘Understanding the variation in treatment intensity among patients with early stage bladder cancer’, Cancer, 378: 3587–3594.Google Scholar
Hsu, J., Price, M., Huang, J., Brand, R.Fung, V. (2006), ‘Unintended consequences of caps on Medicare drug benefits’, New England Journal of Medicine, 354: 2349–2359.Google Scholar
Huskamp, H. A., Keating, N. L., Malin, J. L., Zaslavsky, A. M., Weeks, J. C., Earle, C. C., Teno, J. M., Virnig, B. A., Kahn, K. L., He, Y.Ayanian, J. Z. (2009), ‘Discussions with physicians about hospice among patients with metastatic lung cancer’, Archives of Internal Medicine, 169: 954–962.Google Scholar
IOM (2007), Learning What Works Best: The Nation's Need for Evidence on Comparative Effectiveness in Health Care, IOM Roundtable on Evidence-Based Medicine,. Washington, DC: Institute of Medicine.Google Scholar
IOM (2009), Initial National Priorities for Comparative Effectiveness Research, Report Brief, June 2009, Washington, DC: Institute of Medicine, http://books.nap.edu/openbook.php?record_id=12648.Google Scholar
Jacobson, M., O'Malley, A. J., Earle, C. C., Pakes, J., Gaccione, P.Newhouse, J. P. (2006), ‘Does reimbursement influence chemotherapy treatment for cancer patients?’, Health Affairs, 25: 437–443.Google Scholar
Jeffreys, B. (2007), ‘Fears over NHS cancer drug costs’, BBC, May 14.Google Scholar
Keating, N. L., Landrum, M. B., Rogers, S. O., Baum, S. K., Virnig, B. A., Huskamp, H. A., Earle, C. C.Kahn, K. L. (2010), ‘Physicians factors associated with discussions about end-of-life care’, Cancer, 116: 998–1006.Google Scholar
Kim, P. (2007), ‘Costs of cancer: the patient perspective’, Journal of Clinical Oncology, 25(2): 228–232.Google Scholar
Kolata, G., Pollack, A. (2008), ‘The evidence gap: costly cancer drug offers hope, but also a dilemma’, New York Times, July 6.Google Scholar
Langa, K. M., Fedrick, A. M., Chernew, M. E., Kabeto, M. U., Paisley, K. L.Haymen, J. A. (2004), ‘Out-of-pocket health care expenditures among older Americans with cancer’, Value Health, 7(2): 186–194.Google Scholar
Lubitz, J. D.Riley, G. F. (1993), ‘Trends in Medicare payments in the last year of life’, New England Journal of Medicine, 328(15): 1092–1096.Google Scholar
Malin, J. L. (2010), ‘Wrestling with the high price of cancer care: should we control costs by individuals’ ability to pay or society's willing to pay?’, Journal of Clinical Oncology, 28(20): 3212–3214.Google Scholar
McNeil, C. (2007), ‘Sticker shock sharpens focus on biologics’, Journal of National Cancer Institute, 99(12): 910–914.Google Scholar
Medpac (2010), Report to Congress: Medicare Payment Policy, March 2010, Washington, DC: Medpac.Google Scholar
Meropol, N. J.Schulman, K. A. (2009), ‘Cost of cancer care: issues and implications’, Journal of Clinical Oncology, 25(2): 180–186.Google Scholar
Meropol, N. J., Schrag, D., Smith, T. J., Mulvey, T. M., Langdon, R. M., Blum, D., Ubel, P. A.Schnipper, L. E. (2009), ‘American Society of Clinical Oncology guidance statement: the cost of cancer care’, Journal of Clinical Oncology, 27(23): 3868–3874.Google Scholar
Mukherjee, S. (2010), The Emperor of All Maladies: A Biography of Cancer, New York: Scribner.Google Scholar
Mullins, C. D., Montgomery, R.Tunis, S. (2010), ‘Uncertainty in assessing value of oncology treatments’, Oncologist, 15(Supplement 1): 58–64.Google Scholar
Nadler, E., Eckert, B.Neumann, P. J. (2006), ‘Do oncologists believe new cancer drugs offer good value?’, Oncologist, 11(2): 90–95.Google Scholar
Neumann, P. J., Sandberg, E. A., Bell, C. M., Stone, P. W.Chapman, R. H. (2000), ‘Are pharmaceuticals cost-effective? A review of the evidence’, Health Affairs, 19(2): 92–109.Google Scholar
Neumann, P. J., Palmer, J. A., Nadler, E., Fang, C.Ubel, P. (2010), ‘Cancer therapy costs influence treatment: a national survey of oncologists’, Health Affairs, 29(1): 196–202.Google Scholar
Pearson, S. D.Bach, P. B. (2010), ‘How Medicare could use comparative effectiveness research in deciding on new coverage and reimbursement’, Health Affairs, 29(10): 1796–1804.Google Scholar
Ramsey, S.Schickedanz, A. (2010), ‘How should we define value in cancer care?’, The Oncologist, 15(Supplement 1): 1–4.Google Scholar
Rawlins, M. D.Chalkidou, K. (2011), ‘The opportunity cost of cancer care: a statement from NICE’, Lancet Oncology, 12(10): 931–932.Google Scholar
Schnipper, L. E., Meropol, N. J.Brock, D. W. (2010), ‘Value and cancer care: toward an equitable future’, Clinical Cancer Research, 16(24): 6004–6008.Google Scholar
Schrag, S. (2004), ‘The price tag on progress – chemotherapy for colorectal cancer’, New England Journal of Medicine, 351(4): 317–319.Google Scholar
Schrag, S.Hanger, M. (2007), ‘Medical oncologists’ views on communicating with patients about chemotherapy costs: a pilot survey’, Journal of Clinical Oncology, 25: 233–237.Google Scholar
Schickedanz, A. (2010), ‘Of value: a discussion of cost, communication, and evidence to improve cancer care’, Oncologist, 15(Supplement 1): 73–79.Google Scholar
Shih, Y. C.Halpern, M. T. (2008), ‘Economic evaluations of medical care interventions for cancer patients: how, why, and what does it mean?’, CA: A Cancer Journal for Clinicians, 58(4): 231–244.Google Scholar
Smith, T. J.Hillner, B. E. (2010), ‘Concrete options and ideas for increasing value in oncology care: the view from one trench’, Oncologist, 15(Supplement 1): 65–72.Google Scholar
Smith, T. J.Hillner, B. E. (2011), ‘Bending the cost curve in cancer care’, New England Journal of Medicine, 364(21): 2060–2065.Google Scholar
Slevin, M. L., Stubbs, L., Plant, J. J., Wilson, P., Gregory, W. M., Armes, P. J.Downer, S. M. (1990), ‘Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public’, British Medical Journal, 300: 1458–1460.Google Scholar
Soares, M. (2005), ‘Off-label indications for oncology drug use and drug compendia: history and current status’, Journal of Oncology Practice, 1(3): 102–105.Google Scholar
Sox, H. (2009), ‘Evaluating off-label uses of anticancer drugs: time for a change’, Annals of Internal Medicine, 150(5): 353–354.Google Scholar
Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N. J., Amir, E., Khayat, D., Boyle, P., Autier, P., Tannock, I. F., Fojo, T., Sideroy, J., Williams, S., Camporesi, S., McVie, J. G., Purushotham, A. D., Naredi, P., Eggermont, A., Brennan, M. F., Steinberg, M. L., Ridder, M. D., McCloskey, S. A., Verellan, D., Roberts, T., Storme, G., Hicks, R. J., Ell, P. J., Hirsch, B. R., Carbone, D. P., Schulman, K. A., Catchpole, P., Taylor, D., Geissler, J., Brinker, N. G., Meltzer, D., Kerr, D.Aapro, M. (2011), ‘Delivering affordable cancer care in high-income countries’, Lancet Oncology, 12(10): 933–974.Google Scholar
Sulmasy, D. P. (2007), ‘Cancer care, money, and the value of life: whose justice? Which rationality?’, Journal of Clinical Oncology, 25(2): 217–222.Google Scholar
Szabo, L. (2008), ‘Study: many cancer patients forgoing care because of cost’, USA Today, October 13.Google Scholar
Tangka, F. K., Trogdon, J. G., Richardson, L. C., Howard, D., Sabatino, S. A.Finkelstein, E. A. (2010), ‘Cancer treatment cost in the United States. Has the burden shifted over time?’, Cancer, 116(14): 3477–3484.Google Scholar
Temel, J. S., Jackson, V. S.Billings, J. A. (2010), ‘Early palliative care for patients with metastatic non-small-cell lung cancer’, New England Journal of Medicine, 36(8): 733–742.Google Scholar
Tol, J., Koopman, M., Cats, A., Rodenburg, C. J., Creemers, G. J. M., Schrama, J. G., Erdkamp, F. L. G., Vos, A. H., van Groeningen, C. J., Sinnige, H. A. M., Richel, D. J., Voest, E. E., Dijkstra, J. R., Vink-Borger, M. E., Antonini, N. F., Mol, L., van Krieken, J., Dalesio, O.Punt, C. J. A. (2009), ‘Chemotherapy, bevacizumab and cetuximab in metastatic colorectal cancer’, New England Journal of Medicine, 360: 563–572.Google Scholar
Ubel, P. A., Jepson, C., Baron, J., Hershey, J. C.Asch, D. A. (2003), ‘The influence of cost-effectiveness information on physicians’ cancer screening recommendations’, Social Science and Medicine, 58(8): 1727–1736.Google Scholar
Virgo, K. S., Vernava, A. M., Longo, W. E., Kissling, M. E., Lin, J. C.Johnson, F. E. (1995), ‘Cost of patient follow-up after potentially curative colorectal cancer treatment’, Journal of the American Medical Association, 273: 1837–1841.Google Scholar
Wong, U., Hamilton, O., Egleston, B., Salador, K., Murphy, C.Meropol, N. J. (2010), ‘Understanding how out-of-pocket expenses, treatment value, and patient characteristics influence treatment choices’, The Oncologist, 15: 566–576.Google Scholar
Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T., Mitchell, S. L., Jackson, V. A., Block, S. D., Maciejewski, P. K.Prigerson, H. G. (2008), ‘Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment’, Journal of the American Medical Association, 300: 1665–1673.Google Scholar
Zhang, B., Wright, A. A., Huskamp, H. A., Nilsson, M. E., Maciejewski, M. L., Earle, C. C., Block, S. D., Maciejewski, P. K.Prigerson, H. G. (2009), ‘Health care costs in the last week of life: associations with end-of-life conversations’, Archives of Internal Medicine, 169: 480–488.Google Scholar