New Anticancer Drugs Associated With Big Increases in Costs, but Also Life Expectancy

Given their high cost, there is concern that new, expensive anticancer drugs offer a value in terms of increased life expectancy. David H. Howard, PhD, associate professor in the Department of Health Policy and Management at Emory University in Atlanta, GA, and colleagues, investigated the value of new cancer treatments in routine clinical practice for patients with metastatic breast, lung, or kidney cancer, or chronic myeloid leukemia (CML) for the period from 1996 to 2000 and the period from 2007 to 2011, and found that although there were large increases in medical costs, there were also large gains in life expectancy. The study was published in Health Affairs.

All 73,024 patients in the study received treatment for metastatic or systemic disease and were not candidates for surgery or radiotherapy. Of the total number of patients, 62,865 had lung cancer. Patients were age 65 years or older and continuously enrolled in Part A and Part B of Medicare for at least 12 months after diagnosis.

Among patients with breast cancer who received physician-administered drugs, lifetime costs (including costs for outpatient and inpatient care) increased by $72,000 and life expectancy increased by 13.2 months. Among those who did not receive physician-administered drugs, life expectancy increased by 2.0 months and costs increased by $8900. Life expectancy and costs for patients with lung cancer treated with physician-administered anticancer drugs increased over time by 3.9 months and $23,200, respectively, while remaining unchanged for patients who did not get such drugs. Life expectancy among patients with kidney cancer increased by 7.9 months, and lifetime costs increased by $44,700.

People with CML experienced the largest gain in life expectancy (22.1 months), which can probably be attributed to the introduction of the medication imatinib in 2001. Lifetime medical costs for patients with CML increased by $142,200, of which $126,300 was attributable to Medicare Part D spending. Estimates of life expectancy gains and cost increases for patients with kidney cancer or CML are averages across patients who did and did not receive anticancer drug therapy.

The new study was unique in that it examined survival benefits of new cancer drugs in terms of real-world use, not just those in clinical trials. This has implications because it follows patients taking these medications outside of clinical trials, meaning their regimens may be governed by different patterns of therapy use, drug switching, and combination therapy, and physicians may be better managing their side effects. Thus, patients may be able to remain on the regimens longer than a typical duration of a clinical trial. Finally, physicians can and often do use anticancer drugs in patients who would be excluded form Phase III clinical trials.

Increases in the cost of treating patients with metastatic breast, lung, or kidney tumors or CML were accompanied by meaningful improvements in survival, the authors said. Most of the increases were probably due to the adoption of new anticancer drugs, they conclude.

“Among patients with breast or lung cancer, changes in life expectancy relative to costs were much larger for those treated with physician-administered anticancer drugs than for those who were not,” the authors wrote. “The fact that survival gains were concentrated among patients who received drugs suggests that changes in life expectancy and costs were mainly attributable to changes in the timing of diagnosis or other factors that would have affected all patients diagnosed with metastatic disease.”

The researchers conclude that their results highlight the importance of considering outcomes and overall costs in routine practice when assessing the value of anticancer drugs as a group.