Cancer care is advancing, but policymakers and the cancer care community must find ways to make it more affordable, according to an article published in the October issue of Health Affairs by Lee N. Newcomer, M.D., senior vice president of oncology at UnitedHealthcare.
According to economic studies, the cost of health coverage is projected to reach 100 percent of household income for most American families within the next 20 years if historical trends continue1. These costs are unsustainable and threaten to undermine the progress made in developing new, more effective treatment and care for cancer patients.
“There cannot be a celebration of discoveries if there is no way to pay for them,” writes Newcomer.
The article, titled “Myths and Realities In Cancer Care: Another Point of View,” responds to commentary from health economics experts Dana Goldman and Tomas Philipson in the Health Affairs article, “Five Myths About Cancer Care in America.” Newcomer examines Goldman and Philipson’s five cancer care “myths”: the use of supportive care; cancer treatment at the end of life; treatment costs; detection vs. treatment in survival gains; and the “failure” of the war on cancer.
- Myth 5: Supportive Care is Overused. Newcomer counters by writing that supportive care is undermined by misuse. More frequent palliative care offers a pathway to discussions about patient goals that are critical for assessing the appropriate use and value of supportive care.
- Myth 4: Cancer Care Treatment at the End of Life is of Low Value. Newcomer argues that patients are not willing to pay for more hopeful therapies, as Goldman and Philipson suggest, when that money is their own. Citing analysis of large payer data on oncology patients with retail and specialty pharmacy support, Newcomer found that $50 can deter some patients from purchasing an expensive oncology drug at the end of life, far less than the melanoma study2 cited by Goldman and Philipson that said patients would be willing to pay $54,000 for a hypothetical treatment.
- Myth 3: Treatment Costs Are Unsustainable. While costs are rising and cannot continue at the current pace, it’s not always true that an individual cancer patient’s treatment costs are unsustainable. Out-of-pocket expenses can be managed with the right health coverage. Newcomer writes that “members who purchase insurance with good benefits will pay a higher premium, but their coverage will make their individual cost more sustainable.” He also writes that treatments that have little or no health benefit should be challenged for reimbursement and that cancer patients “should not bear more burden than other severely ill patients simply because they have cancer.” He cites internal UnitedHealthcare data showing that medical oncologists in private practice on average are paid 22 percent above Medicare rates for providing chemotherapy, while hospitals that own oncology practices or employ medical oncologists can use their contractive leverage to earn reimbursements for the same service at an average 146 percent above Medicare rates.
- Myth 2: Detection, Not Treatment, Accounts for Most of the Survival Gain. The number of adult cancers with significant improvement in survival due to treatment breakthroughs is impressive, but the U.S. medical system is missing a great opportunity to quickly learn about new therapies by failing to enroll adults in clinical trials, writes Newcomer. Only about 3 percent of adult cancer patients are enrolled in clinical trials. In contrast, nearly every child cancer patient is enrolled in a trial; as a result pediatric cancer survival has seen impressive results.
Although the number of trials being offered is diminishing in concert with decreased funding and lengthy approval processes, the U.S. cancer research system is giving priority to collaboration, speed and access, resulting in new approaches to treatment.
- Myth 1: The War on Cancer Has Been a Failure. “Progress, even at a slower rate, is not failure,” writes Newcomer. Research shows that advances in the ways that cancer is diagnosed and treated have increased the number of people who live disease-free for long periods of time, according to the National Cancer Institute. “Researchers, patient advocates, and policy makers should, nevertheless, push harder to improve the rate of progress. Finding ways to make cancer care affordable must be an important part of that effort.”
To read the article, click here.
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, and contracts directly with more than 800,000 physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. Globally, UnitedHealthcare serves more than 45 million people in health benefits and is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.
1 Young RA, DeVoe JE. Who will have health insurance in the future? An updated projection. Am Fam Med. 2012;10(12):156–62.
2 Lakdawalla DN, Romley JA, Sanchez Y, Maclean JR, Penrod JR, Philipson T. How cancer patients value hope and the implications for cost-effectiveness assessments of high-cost cancer therapies. Health Aff (Millwood). 2012;31(4):676–82.