Atención oncológica valiosa – NEJM

Value-Based Cancer Care

In June 2015, the American Society of Clinical Oncology (ASCO) published a proposed framework for assessing the value of various cancer treatments. The goal was to evaluate selected treatment regimens on the basis of their clinical benefit, toxicity, and cost. ASCO’s ideas about cost had been incubating for a long time: the organization had created a Task Force on the Cost of Cancer Care in 2007, although, like most medical specialty organizations, it had generally remained silent on the issue of cost. But the cost of cancer care has been growing rapidly: though it accounts for a relatively small portion of overall U.S. health care expenditures, it is expected to increase from $125 billion in 2010 to $158 billion in 2020.

The costs of cancer drugs amount to only 5 to 20% of the total costs of cancer care, depending on how many of the multiple cost components are included. But the average cost of some newer cancer drugs is now $10,000 to $30,000 per month, and combinations of checkpoint inhibitors cost as much as $100,000 per month. Virtually none of these treatments are curative, and some improve only disease-free survival, not overall survival. The costs of copayments, out-of-pocket expenses, and rising insurance premiums exceed many patients’ capacity to pay. A 20% copayment for checkpoint inhibitors might cost the patient $60,000 for a full course of treatment. Many patients elect to simply forgo treatment.

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