Driven by newer agents, the cost of US oncology medicines has increased 88% over the past 5 years, according to the QuintilesIMS Institute Global Oncology Trends 2017 report. New therapies since 2011 have added $13.6 billion to the cost of oncological care. Overall, the cost of oncology agents reached $44.1 billion in 2016, a rise of $20.7 billion since 2011.
Costs of older, patent-protected drugs also increased owing to wider usage and the tendency of manufacturers to increase prices after drug launches, the report said. Branded drug volume added $3.4 billion to the cost of oncological medicine between 2011 and 2016, and increases in brand prices added another $5.8 billion.
Meanwhile, the loss of patent exclusivity for some older brands resulted in a $4.8 billion reduction in drug costs, while increased use of generics added $2.6 billion to costs. The United States still leads the world in oncology spending, with a $52.1 billion domestic tab in 2016. That amounts to 46% of global oncology costs, up from 39% in 2012, according to the QuintilesIMS report. Global costs of oncology and supportive care therapies climbed to $113 billion in 2016, notching a compound annual growth rate of 11.6%.
Growth in the overall cost of cancer treatments is expected to be in the range of 6% to 9% annually through 2021, but actual drug price increases will range from 2% to 5% annually, the report said. Whereas invoice (sticker) prices of on-patent drug brands have grown at close to 5% or above since 2011, net price increases have been more modest, a result of price concessions made by manufacturers. Those concessions include mandatory and negotiated rebates, discounts, and patient cost offsets. Use of coupons to offset patient out-of-pocket costs is growing: the average patient cost offset has exceeded $500 per prescription over the past 5 years.
The wide-ranging study also discussed the rapid incorporation of immuno-oncology drugs into treatment lines, expanded indications for established drugs, declines in mortality, and the rising complexity of cancer care.
The development of many new therapy options has made life much more complex for oncologists trying to decide the best way to approach disease management, QuintilesIMS Institute said. In many cases, multiple agents with similar mechanism of action have been approved in quick succession, often with only limited clinical data to guide decision making. Since 2011, 68 new drugs have been approved for 22 indications.
The dramatic increase in the number of patients treated for melanoma since 2011 illustrates how new therapies have changed the landscape of cancer care, the report said. In the United States, 22,200 patients with melanoma were treated in 2016, up from 8,900 in 2011. This reflects the newer, more-effective treatments available for patients who, several years ago, had significantly fewer options for care.
“In the case of advanced melanoma, several novel therapy classes, including PD-1 inhibitors, BRAF inhibitors, MEK inhibitors, and anti-CTLA4 have launched in the last 5 years and resulted in [nearly] tripling the number of treated patients,” the report said. The arrival of immuno-oncology agents has considerably changed the treatment paradigm for some disease types. In non–small cell lung cancer (NSCLC), PD-1 inhibitors have seen a sharp uptake since 2013, with 27,433 patients treated in the United States. Treatment has branched away from monotherapies which historically were the mainstay in NSCLC, the report said. In particular, the increase in duration of response in NSCLC has fueled growth in use of the PD-1 agents nivolumab (Opdivo) and pembrolizumab (Keytruda).
But in NSCLC, as with several other disease types, treatment options are vastly more complex than they were a decade ago. In 2006, treatment for metastatic NSCLC extended as far out as second-line chemotherapy or erlotinib (Tarceva). Today, there are multiple second- and third-line options, most of which are biomarker driven. This requires tissue samples that are difficult to obtain. Although agents for NSCLC have proliferated, the supply of useful clinical trial data has not kept up, adding to the difficulty of choosing from among different agents, the report said.
Biomarker testing should be more robust than it is, the report added, noting a survey of nontesting rates across different cancers in 2016. PD-L1 and KRAS nontesting rates in lung cancer were highest at 55% and 52% respectively. The survey of oncologists (n = 425) showed that approximately 13% and 18% of patients with NSCLC did not receive an EGFR biomarker test or ALK test, respectively, even though those tests are recommended.