Our topic for the upcoming #LCSM tweet chat on Thursday, April 24 at 8 PM Eastern, 5 PM Pacific is the question of “cost vs value” in cancer treatments. The moderator for this chat will be Dr. Jack West.

ASCO (American Society of Clinical Oncology) has recently announced an initiative to define value in cancer treatments and apply some expectations of which drugs should be used, given their remarkable cost. Newer medications are typically costing about $10,000 per month, and the price is rising rapidly.

Newer drugs have varying amounts of evidence to support their use in lung and other cancers. For some targeted drugs, the evidence is compelling: patients who have a specific driver mutation have response rates of 60-75%, profound tumor shrinkage, and a duration of response of a year or longer. But there are also pricey drugs that offer a marginally significant clinical benefit. Is six weeks of additional survival with no chance of a cure worth an extra $50,000 per patient? Is it fair to expect society to pay for those marginal benefits?

The increasing use and plummeting cost of genomic testing will catalyze this cost versus value discussion. A cancer tumor’s genomic profile may identify a mutation for which a targeted drug exists. Such a tantalizing lead is likely to encourage a patient or oncologist to a try new, expensive drug or other treatment when it hasn’t been tested on that patient’s type of cancer. For instance, a drug approved for BRAF in breast cancer may have little or no clinical evidence to indicate it will actually work on a lung cancer tumor. Whether such experimental treatments perform spectacularly or fail, they will certainly cost a lot, and some patients may expect their health insurance to cover it.

The FDA has been charged with making decisions about drug approvals without regard to cost vs value, Yet increasing use of newer, expensive cancer drugs could drive up the cost of healthcare insurance premiums for everyone. Escalation of premiums can be crippling for families. It’s difficult to justify the burden of increased premiums for all when the benefit of an approved cancer drug is underwhelming.

How can we provide the best opportunities for patients while being fiscally responsible with limited societal resources? And how can we ensure that if society is paying for experimental treatments, someone learns something from it that can lead to a greater understanding and improved treatment recommendations later?

With these broad ideas in mind, here are the 3 key questions in our upcoming tweet chat on Thursday:

T1: @ASCO is now evaluating “value” of cancer drugs, as new ones are now ~$10K/mo. Is it fair to potentially deem some not worth cost? #LCSM

T2: How can we address societal concerns around rising costs & unproven or marginal benefits of cancer drugs that aren’t curative? #LCSM

T3: Would it be fair & feasible to have unproven agents provided, covered by insurers, only if pts & their docs submit outcomes data? #LCSM

We hope you’ll join us. Please just add the hashtag #LCSM to your tweets at the appointed hour and follow the stream as best you can. More info on how to participate in #LCSM Chat is here.

Background Reading

At What Price? Discussing Cost of Care with Patients, in ASCO Connection