Episode 12 - Cost Considerations and Comparative Effectiveness Research

During this segment, Peter Salgo, MD; John L. Fox, MD, MHA; Ira M. Klein, MD, MBA, FACP; Michael Kolodziej, MD; Bryan Loy, MD; and Irwin W. Tischler, DO, note that the Centers for Medicare & Medicaid Services (CMS) is prohibited from considering the costs of therapy when evaluating whether to cover a new treatment option. The panelists also consider how the use of comparative effectiveness research (CER) may help address the financial challenges in medical oncology.

Drs Fox and Tischler explain that legislation currently prohibits CMS from considering cost when deciding whether to cover a treatment option. Dr Fox adds that this poses a problem, as new options can be expensive, yet lawmakers do not want to raise taxes. However, he says, taxpayers are still affected because private payers are forced to increase premiums to cover expensive drugs.

Higher patient costs (eg, co-pays) are associated with higher rates of nonadherence to therapy, notes Dr Klein. Thus, the cost of treatment creates an informal form of rationing. CER could be used to help address these challenges, comment Drs Fox, Klein, and Tischler, by identifying the most cost-effective therapies.

However, Dr Loy explains that because research is ongoing and additional drugs are in the pipeline, CER may not always be relevant or up-to-date. In the absence of CER data, the main drivers that affect treatment decisions include costs and side-effect profiles.

In terms of end-of-life and palliative care discussions, Drs Fox, Kolodziej, and Loy agree that the cancer care team can help reduce the financial burden of oncology treatments on patients and their families by discussing priorities and care preferences earlier in the patient’s course of care, and routinely delivering additional information over time.