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Assessing the Cost of Cancer Care

Panelists:Michael Kolodziej, MD, Aetna; Andrew L. Pecora, MD, FACP, CPE, John Theurer Cancer Center; Jeffery C. Ward, MD, Swedish Cancer Institute
Published Online: Friday, Sep 18, 2015


Tremendous advancements in oncology have led to increasing costs, and this trend is expected to continue. However, oncologists should be critical of the quality of the evidence and ensure that the regimen constitutes a real benefit, says Michael Kolodziej, MD.

Given the approximately 220,000 new lung cancer diagnoses each year, 85% of which develop metastatic disease, the cost of treating each patient with a novel therapy would be astronomical. A large percentage of those individuals will ultimately not benefit from the therapy, Kolodziej adds, representing substantial waste. Future research needs to focus on biomarker development so that the right patient gets the right treatment.

Several legislative initiatives are underway that are meant to incentivize the right level of care. It is important to recognize, notes Jeffrey Ward, MD, that these efforts are insurance reform, not healthcare reform. Although access to care has improved under the Affordable Care Act (ACA), many people are still underinsured, he adds.

Patients with cancer have benefited from the ACA in terms of no-cost screening and the abolishment of the pre-existing condition clauses. The repeal of the sustainable growth rate formula will encourage the use of alternative reimbursement models, notes Kolodziej. Centers for Medicare & Medicaid Services programs, including the Oncology Care Model, are going to be a catalyst for change, he says.
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Tremendous advancements in oncology have led to increasing costs, and this trend is expected to continue. However, oncologists should be critical of the quality of the evidence and ensure that the regimen constitutes a real benefit, says Michael Kolodziej, MD.

Given the approximately 220,000 new lung cancer diagnoses each year, 85% of which develop metastatic disease, the cost of treating each patient with a novel therapy would be astronomical. A large percentage of those individuals will ultimately not benefit from the therapy, Kolodziej adds, representing substantial waste. Future research needs to focus on biomarker development so that the right patient gets the right treatment.

Several legislative initiatives are underway that are meant to incentivize the right level of care. It is important to recognize, notes Jeffrey Ward, MD, that these efforts are insurance reform, not healthcare reform. Although access to care has improved under the Affordable Care Act (ACA), many people are still underinsured, he adds.

Patients with cancer have benefited from the ACA in terms of no-cost screening and the abolishment of the pre-existing condition clauses. The repeal of the sustainable growth rate formula will encourage the use of alternative reimbursement models, notes Kolodziej. Centers for Medicare & Medicaid Services programs, including the Oncology Care Model, are going to be a catalyst for change, he says.
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