As
scientists continue making breakthroughs in personalised cancer treatment,
delivering those therapies in the most cost-effective manner has become
increasingly important. Now researchers at the University of Colorado School of
Medicine have identified new ways of doing just that, allowing more patients to
benefit from this revolution in cancer care.
In a paper health economist Adam Atherly, PhD, of
the Colorado School of Public Health (CSPH) and medical oncologist D. Ross
Camidge, MD, PhD, of the University of Colorado Cancer Center, argue the cost
of profiling patients’ tumours for specific molecular abnormalities must be
considered. This kind of molecular profiling is increasingly being used to
determine who would benefit most from a variety of cancer drugs. In addition,
many new drugs are now being restricted to cancer patients with specific molecular
sub-types of the disease. Many of these initial breakthroughs have happened in
lung cancer, but dividing one disease into many different sub-diseases at the
molecular level is expected to extend across most of cancer medicine in the
next few years.
"In recent years, we have championed the
practice of performing very sophisticated molecular tests on the tumours of
every lung cancer patient we see. We then use this information to direct
patients to the most appropriate targeted therapy for their cancer," said
Camidge, CU Cancer Center investigator and director of the thoracic oncology
clinical program at University of Colorado Hospital (UCH).
Camidge continues, "The testing has certainly
led to major breakthroughs in the treatment of lung cancer. But if we are going
to roll these developments out across the U.S. and around the world, we have to
understand what this progress costs and how to make it affordable."
Many insurers already consider the cost of a drug
and the benefit derived from its use when determining coverage. In their paper,
Atherly and Camidge reveal that the cost of testing tumours for an increasing
array of specific genetic abnormalities must now also be considered.
"If you screen every patient with a molecular
test to detect something that only occurs in one percent of them – in reality,
treating each positive patient should also include the up-front costs of
screening the other 99 negative patients," said Atherly, professor of
health systems management and policy for the Colorado School of Public Health.
"If a test costs $1,000, this means from society’s perspective you have to
add $100,000 to the costs of treating each of the one in 100 patients that are
positive. And this is before you have even started to consider the cost of the
drug itself. When you consider these factors, some organisations may not view a
new drug as cost effective even if it works amazingly well for the small
percentage who are proven positive by the test."
Using recent breakthroughs by the University of
Colorado's lung cancer program to model their data, Atherly and Camidge argue
pricing of the molecular profiling tests and policies on who and how to screen
for abnormalities should be carefully considered or treatment of many different
cancers may be delayed. They suggest two key ways molecular profiling can be
made more cost effective. First, clinicians could recommend testing only some
patients based on finding certain key clinical factors that increase the
chances of a patient having a specific molecular abnormality in their tumour.
The downside is that some positive patients may be missed if they don’t fit a
classical stereotype. Second, either the cost of the profiling test for each
individual molecular abnormality has to be reduced for every patient screened,
or tests must be merged so doctors can look for multiple different
abnormalities at the same time at a lower combined price.
"We believe the only way to beat cancer is
moving away from the one-size-fits-all model," said Camidge. "To do
this we must treat every person as an individual. But if we don’t think now
about the costs of this approach and how to address them, these breakthroughs
will never achieve their true potential."
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