VIDEO ALERT: Video of Dr. Rajkumar discussing the commentary is posted on the Mayo Clinic News Network.
“Cancer care is not representative of a free-market system, and the traditional checks and balances that make the free-market system work so efficiently in all other areas are absent when it comes to most cancer treatment,” write authors, Mustaqeem Siddiqui, M.D., an oncologist and Vincent Rajkumar, M.D., a hematologist.
For example, when it comes to antibiotics to treat a given infection or over-the-counter painkillers, a physician or patient can choose between multiple drugs that do the same thing. But cancer drugs are administered to patients sequentially or in combination, creating a virtual monopoly for each drug. This is one of the principal reasons for the high cost of cancer therapy.
Other factors include the expense of drug development; the high price that patients and insurers are willing to pay for even modest improvement in outcomes; and a lack of regulations such as a cost effectiveness analysis to account for economic and value-based considerations in the drug approval and pricing process, the physicians write.
Solutions the authors recommend include:
- Value-based pricing that includes discrete metrics such as an incremental cost effectiveness ratio per quality-adjusted-life-years gained, as a result of a particular treatment. Quality-adjusted-life-years is an estimate of the number of years added to a patient’s life by a specific drug intervention, adjusted for quality of life.
- A U.S. Food and Drug Administration mandate requiring drug companies to submit a value dossier when seeking drug approval. This information would give patients and physicians the ability to make better-informed decisions about treatment.
- Centers for Medicare and Medicaid Services powers to negotiate payments for cancer drugs.
- Improved national cancer guidelines providing evidence-based analysis of quality of life, mortality data, benefits, risks and cost for all possible treatment options.
- Monopoly rules to determine if a particular drug will operate in a monopoly situation. Such drugs would be subject to legally mandated or voluntary price controls in exchange for expedited approval or other remedy.
- Non-profit generic drug companies to manufacture and distribute generic cancer drugs at a very low cost.
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