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Patients treated outside NCI centers less likely to receive high-cost lung cancer drugs

Patients treated at NCI-designated cancer centers were 10% more likely to be given these drugs than were patients treated in other settings.

Jeff Lagasse, Associate Editor

Genetically targeted drugs and immunotherapies are transforming the way many forms of lung cancer are treated. But a University of Colorado Cancer Center study published in the Journal of the National Cancer Institute shows that while the use of these drugs rose 27% from 2007 to 2015, new, high-cost lung cancer drugs are not used equally in all places, with all patients.

Patients who lived in high-poverty areas were 4% less likely to be treated with high-cost lung cancer drugs. On the other hand, patients treated at National Cancer Institute-designated cancer centers were 10% more likely to be given these drugs than were patients treated in other settings.

The findings suggest that in addition to the socioeconomic disparity in the use of these drugs, the fact that they are used more often at NCI-designated cancer centers also implies a disparity between treatment centers that are research-oriented and those that are not.

WHAT'S THE IMPACT

The authors examined the data of Medicare patients from 2007-2015, exploring how race/ethnicity, urban or rural residency, poverty and treatment facility type were associated with the use of drugs costing more than $5,000 per month in patients diagnosed with metastatic (stage IV) non-small cell lung cancer.

Medicare spending during the 12 months following diagnosis was lower for rural patients by about $17,000 per patient.

Putting aside the question of Medicare's affordability or sustainability, uneven access to specialized care due to poverty or location may explain some of the observed disparities.

Currently the Centers for Medicare and Medicaid Services is forbidden by law to negotiate prescription prices with drug manufacturers. Likewise, the FDA is disallowed to take into account a drug's price when considering approval -- unlike its counterpart in Europe, the European Medicines Agency.

These factors, and others, mean that as new and more expensive anti-cancer agents are developed, the cost to society increases as a whole, and to individuals who pay indirectly for the use of these drugs through insurance premiums, without taking into account increases in drug effectiveness that could establish the value added by the new drugs.

THE LARGER TREND

While cancer deaths have been declining since the early 1990s, costs have continued to increase, with more than $147 billion spent for cancer care in the U.S. in 2017.

Despite these rising costs, employers and health plans have been reticent to manage oncology care, and are also faced with keeping pace with technology and treatment advances.

Focus on Patient Experience

This month, our coverage will continue a special focus on the patient experience. We'll talk to the thought leaders and first-movers reimagining the how and where of patient-friendly tech, and report on ways to activate, if not delight, the people they treat.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com