Studying Cost, Efficacy of Cancer Care

By 2020, annual spending on cancer care is expected to exceed $158 billion in the United States. With an aging population and therapy regimens that often top $100,000 a year per patient, costs are rising at an unsustainable rate, says Scott Ramsey, MD, PhD, a member of the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center in Seattle.

Ramsey, a physician and health economist, has been named director of Fred Hutchinson's Institute for Cancer Outcomes Research and Evaluation (ICORE), set to officially launch in early 2013. “Our mission is to improve the quality of cancer care and to reduce the cost for patients and the healthcare system,” he says.

The price of cancer drugs, particularly in newer combination regimens, has reached a crisis level, says Ramsey, one example being that “cancer patients have bankruptcy rates 3 to 8 times as high as people in the general population.” He notes that as prices rise, costs will be transferred to patients in the form of higher co-pays.

“We want drug companies to recoup their expenses and make a profit, but it's society as a whole that will ultimately decide whether it's worth spending $100,000 to $200,000 to gain an extra month of life,” Ramsey points out.

Overall, ICORE will study outcomes, cost-effectiveness of prevention and early detection and treatment, pragmatic clinical trial design, and health policy.

One important effort will be to examine ways to reduce the use of diagnostics and treatments that appear to offer little to no survival benefit, but are being prescribed widely off-label or against clinical practice guidelines.

Another primary focus of the new Institute will be to reduce disparities in cancer care that are based on socioeconomic or geographical barriers. “In study after study, we find patients with very similar clinical problems who are either not getting the care they need or are receiving care that isn't shown to be beneficial,” says Ramsey.

The Institute's efforts will build on collecting and analyzing large volumes of data that are typically in silos, such as cancer registries, electronic medical records, and insurance claims.

“Cancer treatment has traditionally relied on information from clinical trials, but only 3% to 5% of all cancer patients enroll in clinical trials,” notes Ramsey. “The other 95% receive standard care in their communities. Our goal is to try to collect that extra information, link all these databases so that we can get a better picture of cancer patients' experiences, and make that information available to other researchers.”

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