OBR Daily Commentary

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Cancer Care Costs in the United States Are Projected to Exceed $245 Billion by 2030

(AACR) June 10, 2020 - The national cancer-attributable costs in the United States are projected to increase by over 30 percent from 2015 to 2030, corresponding to a total cost of over $245 billion, according to a new study. “Rising health care expenditures are a burden for patients, and costs of cancer care has become a critical topic in patient-provider discussions to facilitate informed decision-making,” said study author Angela Mariotto, PhD, chief of the Data Analytics Branch at the National Cancer Institute (NCI) in Bethesda, Maryland.

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William McGivney, PhD (Posted: June 11, 2020)

quotesThis comment relates to the article described by Mariotto et al that projects that “Based solely on population changes due to aging and growth, the researchers estimate that the national costs for cancer-related medical care and oral prescription drugs in 2030 will be $221 billion and $25 billion, respectively, totaling nearly $246 billion. This represents a total increase in national cost of 34 percent.” Quite frankly, a 34% increase in terms of increase over a 15-year period seemed somewhat tame. It is understood that the projection is based “solely” on population changes. I found a similar analysis done by the same group and published in 2011 in JNCI. This article by Mariotto et al estimated that for the period 2010 through 2020, with a constant incidence and survival and costs of care, Cancer-attributable medical costs would rise by 27%. Again, the 27% percent increase in the total medical costs “reflects growth and aging in the population only”. In this 2011 article, a sensitivity analysis was applied to evaluate the impact of advancing technology (e.g., testing, biologics) and projected that with a 5% annual increase in costs of care, Cancer attributable medical costs would increase by 66% from 2010 to 2020. As such, the application of reasonable “costs of cancer care” factor by the authors is necessary to arrive at a more robust estimation of what can be expected in terms of total increase in the national Cancer-attributable medical costs across defined periods of time. quotes

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ICER Presents Alternative Pricing Models for Remdesivir as a Treatment for COVID-19

(ICER) May 1, 2020 - The Institute for Clinical and Economic Review (ICER) today released the results of its initial analyses to inform public debate of pricing for remdesivir (Gilead Sciences) and other future treatments of COVID-19.

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William McGivney, PhD (Posted: May 05, 2020)

quotesICER steps in to take advantage of “informing the public debate” (I did not know we were there yet) regarding pricing for remdesivir. Clearly, the presentation of pricing models for remdesivir also affords enhanced visibility for ICER in addition to being first in “informing the public debate”. With all such analyses, the societal ravages of this pandemic in the United States must be fully considered as well as the suffering experienced by individual symptomatic patients and their caregivers. Also, before I weigh in, it must be recognized that Gilead has pledged to provide 1.5 million doses of remdesivir for compassionate use, expanded use, and clinical trials. ICER proposes a model of cost recovery that recommends $10 per 10-day dosing course. The cost recovery model arrives at this pricing recommendation after including production costs such as active pharmaceutical ingredients, costs of excipients, packaging and a small profit margin (definitely sounds small does it not?). The costs of R and D were set to “zero” given that research on remdesivir in hepatitis C was included in a “suite of agents” with some agents already successfully launched and marketed for hepatitis C. Huh? Are we not talking about COVID-19, the disease caused by this new coronavirus. Huang et al way back in 2005 in J of Gastroenterology and Hepatology discuss the similarities between the hepatitis C virus and the “novel coronavirus SARS CoV”. Similarities include single strand RNA viruses, elevated blood IL-8, etc. The COVID-19 virus then differs from the SARS CoV in important ways. Clearly, anyone indicating that research on Hep C patients can be applied directly to define the safety and efficacy of the treatment of COVID-19 would be laughed, if not driven out of any reputable scientific/clinical meeting. Regardless we are at an ICER-recommended price of $10 for a 10-day course of remdesivir for COVID-19. The ICER Cost-effectiveness model proposes $4500 as a high-end appropriate price for a 10-day treatment. The model captures QOL improvements, mortality benefits (undefined as yet), fewer hospital and ICU days. Given a general hospital treatment reduction from a stay of 15 days to a stay of 11 days (per the NIAID initial study results) what would the per patient cost-savings be for that; never mind the benefit to patient clinical outcomes. Someone else please do the calculation. ICER advances its recommendations acknowledging the “great clinical evidence uncertainty”. So, at $10 per patient per one million patients, we would spend $10 million and at $4500 per patient for 1 million patients we would spend $4.5 billion. Given the potential impacts on individual patient health, societal public health, and the nation’s economy, we will need others to participate in the coming public debate. quotes

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New Article Analyzes Impact of PBMs on Quality Cancer Care

(ASCO in Action) Apr 20, 2020 - Today the JCO: Oncology Practice published an article and accompanying infographic that examine the impact pharmacy benefit managers (PBMs) have on cancer care delivery. The article is part of the American Society of Clinical Oncology’s (ASCO) State of Cancer Care in America (SOCCA) series, which explores challenges and opportunities in today’s oncology delivery system.

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William McGivney, PhD (Posted: April 27, 2020)

quotesHere we go again! It is important and necessary to keep pointing out the intrusion of PBMs into medical decisions that impact the lives of patients with serious and life-threatening conditions, in our case, cancers. The JOP article repeats a 2018 survey and confirms the findings of an “opaque” system of utilization management activities. “Clandestine” and “surreptitious” might be more apt descriptors. Again, this opaque system persists despite the fact that executives in PBMs would not want decisions about their or their family’s treatment for cancer made by their own minimally-qualified UM overseers. Certainly, the same sentiment resides in regulators, legislators etc. I know from my experience at a major insurer, wherein in my final days I was put in charge of the UM docs, that I would never have wanted any of them to be involved in any manner whatsoever in a clinical decision that impacted anyone who I knew and cared for. I keep telling the same stories of a senior lawyer at that insurer that I worked for telling me upon her departure that the best thing about leaving was that she would not have to say again that we do not make medical decisions. Also, I have recounted the story of the world-renowned NCCN Panel Chair who had a cardiology PBM nurse explain to him the meaning of an NCCN recommendation. He listened and then kindly informed her that he had been the Panel Chair for 20 years and this is what the recommendation actually meant. The administrative waste, the opacity of financial arrangements, the denial of optimal first treatment, the patient frustration and anguish just do not seem to raise the issue to a point where we might see change. quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Associate Clinical Professor, Medical Oncology Executi...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics Professo...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Steven Spielberg Family Chair in Hematology Oncology P...

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Stephen M. Schleicher, M.D., MBA

Community Oncology, Medical Oncologist, OneOncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Health Policy
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William McGivney, PhD

National Health Policy Expert...