Oncology Rx Treatments – Is An Extra Two Months of Life Worth $500,000?


Based on a Cigna study, less than ½ of the oncology drugs approved from 2009-2014 have a known survival benefit…………..

Insurers Digging Through the Numbers on Oncology Treatments

by Larry Kirshner on May 30, 2017

One of the most difficult issues we face as a society is the cost of care for people who are terminally ill. In fact, most of a person’s lifetime healthcare spend is incurred at the end of their lives. With the advent, and ongoing issue, of skyrocketing pharmaceutical costs insurers are looking closely at the cost-versus-benefit factor of new-to-market, high-cost oncology treatments. Based on the early returns, the benefits may not be worth the costs. This could ultimately lead to a collision course with insurers and other payors holding the cards on decisions that members receive – even more than they do now.

This is obviously a slippery slope to tell someone that a $500,000 treatment is not going to be paid based on clinical evidence that it will only grant, for example, another four weeks of life. To a terminally ill patient four more weeks may feel like four more years and afford them the opportunity to spend this time with their family.

Even hospitals are getting into the mix. An op-ed piece a few years back in The New York Times from high-ranking providers at New York’s Memorial Sloan-Kettering Cancer Center severely questioned the pharmaceutical industry’s logic and ethics for their pricing of the new-to-market drugs and their overall value. And the hospital had made the decision to restrict access to certain high-cost medications.

So what are the numbers saying? Based on a Cigna study, less than ½ of the oncology drugs approved from 2009-2014 have a known survival benefit. There are numerous examples. One is a regime of 5-FU + Leucovorin at a cost of $5,000 per treatment with an estimated survival outcome of 12 months versus the drug Xeloda which costs $30,000 and estimates survival at 13.2 months. Another issue the Cigna report raised is that one in three patients who are treated with chemotherapy do not receive treatment based on evidence-based care.

The continued shift to value-based medicine is going to require everyone to make hard decisions on the ongoing use of certain treatments. The process is beginning.