Discussion:
- Access and affordability: This is simultaneously an environment where we have made exceptional strides in turning cancer into a chronic disease and adding years to life. At the same time, we still struggle with access and affordability. On the affordability front, the cost of the therapies including the drugs and immunotherapy has implications for access. With such a prevalent and horrible disease as cancer, ideally you would want treatment to be 100% accessible. We need a healthcare system that is dramatically improved in quality, dramatically improved in access, and dramatically improved in affordability and sustainability for patients, doctors, employers, and the country. Quality, access, and cost are major challenges that are going to require transformative change. With access, one in four Americans will defer care because of cost reasons. One in three Americans will not take prescription drugs because of cost. One of the major causes of personal bankruptcy is healthcare. We have a highly inefficient system. Out of the $3.5 trillion that we spend on healthcare in this country, which is close to 19% of our gross domestic product, about $700 billion to $900 billion is wasteful care.
- Geographic barriers: In our case, we get a lot of patients who come from all over the country and all over the world. We get many patients who come to us after they have tried treatment at their local hospital. It’s a major journey for these patients to travel. By offering telehealth and partnering with local providers, we are trying to bridge this gap. But just because you have wonderful new therapies and protocols at facilities like ours, it doesn’t mean that everyone can overcome the geographical barriers to access them.
- Time: There might be a clinical trial that is in its infancy but it’s so close to unlocking an important scientific discovery that I would wish that I could get it to patients today instead of a year from now. Time is also a factor in catching disease early and preventing disease. Just like with cardiac care and diabetes, there are lots of things that can prevent cancer, up to 50% of cancer is preventable. Through prevention and very early detection and diagnosis, we can stop cancers at the cellular level before they progress to more complex diseases. Often, the treatment side gets the most attention, more dollars, and more resources. Treatment is very important, but we need to pay as much attention to devoting dollars and resources to prevention and diagnosis. References National Cancer Policy Forum; Board on Health Care Services; Institute of Medicine. Delivering Affordable Cancer Care in the 21st Century: Workshop Summary. Washington (DC): National Academies Press (US); 2013 May 20. CURRENT CHALLENGES. Available from: https://www.ncbi.nlm.nih.gov/books/NBK202475/
van de Haar J, Hoes LR, Coles CE, et al: Caring for patients with cancer in the COVID-19 era. Nat Med 26:665-671, 2020 [Erratum: Nat Med 26:1146, 2020]
Discussion Response:
Nicely summarized post. I agree with you that the cost of drugs and/or treatment within the United States has become unreasonable and is resulting in patients having to make decisions between food on their table or medicine for their disease. Rajkumar (2020) found that global spending on prescription drugs averaged $1.3 trillion in 2020, with the United States making up $350 billion of the total. Globally, spending on prescription drugs is expected to increase 3%-6% year on year. Hunter (2011) reported that the average price of a life-saving oncology drug can cost $100,000-$150,000 annually in the US.
Reducing the price of prescription drugs has no easy solution, especially in markets like the United States where there are no government controlled price caps or value-based pricing requirements. Fundamental changes to global and United States (US) policies are necessary if drug prices are lowered, but careful consideration must be taken to appropriately compensate pharmaceutical companies for the costs associated with research and development. It is an extremely delicate balance that requires transparency and input from all key stakeholders.
References
Hunter, J. (2011). Challenges for pharmaceutical industry: new partnerships for sustainable human health. The Royal Society, 369, 1942. https://doi.org/10.1098/rsta.2010.0377.
Rajkumar, S. V. (2020). The high cost of prescription drugs: causes and solutions [Editorial]. Blood Cancer Journal, 10(71). https://doi.org/10.1038/s41408-020-0338-x.
