Oncology is the area where the health care cost conundrum is coming into sharpest focus. Theoretically, who wouldn’t spend whatever it takes to cure a life-threatening disease? And yet practically the costs of new treatments are so high, and the improvements usually modest enough, that when it comes right down to it costs are becoming a real issue for patients and doctors.
An interesting article in the Journal of Clinical Oncology explores the attitudes of US and Canadian oncologists. From a survey of hundreds of oncologists they conclude that views of the two countries’ oncologists are similar, despite the fact that Canadians practice in a system where some chemotherapy drugs are not covered due to their cost, while in US society as a whole it is taboo to even talk about cost effectiveness or “rationing.”
A few highlights from the article:
- 84% of US and 80% of Canadian oncologists agree that,”Patient ‘out of pocket’ costs currently influence my decisions regarding which cancer treatments to recommend for my patients.” (Note that while there is little out-of-pocket spend in Canadian health care in general, patients do have to pay for certain drugs that aren’t covered)
- 67% of US and 52% of Canadian oncologists say, “Every patient should have access to effective cancer treatments regardless of their cost.” Note that even in the US this means one-third of physicians think costs should be a deciding factor
- 58% of US and 75% of Canadian oncologists agree that, “Every patient should have access to effective cancer treatments only if the treatments provide ‘good value for money’ or are cost effective.” And yet only 42% of US and 49% of Canadian oncologists said they were well prepared to interpret and use cost-effectiveness information for treatment decisions
On policy issues:
- 57% of US and 68% of Canadian oncologists favored price controls for cancer drugs by Medicare
- 80% of US and 69% of Canadian oncologists thought there should be more use of cost-effectiveness data in coverage and payment decisions. (The lower number for Canadians is probably due to the fact that cost-effectiveness information is already used for this purpose)
- 79% of US and 85% of Canadian oncologists want more government research on comparative effectiveness of cancer drugs
Many ideological foes of health reform and comparative effectiveness research think that all would be well if decisions were left up to doctors and their patients. But oncologists already take costs into account and favor cost-effectiveness research, so life (and death) might not actually change much.
In my opinion, we should support more and higher quality comparative effectiveness research, then train doctors and patients to interpret and act on it.
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