Article 1: American Society of Clinical Oncology Guidance Statement: The Cost of Cancer Care
Although the great advances made in the diagnosis, prevention, and treatment of cancer have significantly mitigated cancer-related mortality in the US, they have been paralleled by significant increases in the costs of cancer care. The cost of overall health care as well as cancer care in the US is growing faster than the national GDP. The spiraling of cancer care costs is in part due to high prices and rapid assimilation of novel drugs and technologies. Conventional knowledge suggests that the high prices reflect the risks and costs linked to the development, production, and sale of these new drugs and therapies. This article is a guidance statement whose focus is on the cost of cancer care. It was authored by the Cost of Care Task Force established by the American Society of Clinical Oncology (ASCO) in response to the rising costs of cancer care. The professional association, ASCO, is committed to enhancing cancer prevention, detection, and treatment and the alleviation of disparities in cancer care via support of evidence-based, cost-effective practices. The Cost of Care Task Force was established to address concerns related to the escalating costs of cancer care.
The guidance statement provides an overview of the economic issues faced by the various stakeholders in cancer care. The escalating costs of cancer care affect and are also driven by the various stakeholders of the complex health care system that is, physicians, patients, industries, and payers. Patients are most vulnerable to these costs on account of uneven insurance coverage that often makes them experience financial strain or ruin. Pharmaceutical industries pass the costs of research development, and marketing to consumers. Oncologists prescribe expensive drugs and technologies. Insurance companies, on the other hand, pass costs to consumers. If this trend continues, an increasing number of Americans will be unable to afford cancer care.
The article also recommends measures for addressing the most pressing needs. These steps include recognition of the importance and subsequent integration of discussions on costs of cancer care during patient-physician interactions, development of educational and support tools for oncologists to foster effective communication on costs with patients, and design of educational resources for patients that help inform their decisions on treatment options. The guidance statement further recommends that ASCO comes up with policy positions that address fundamental drivers of costs of cancer care. This task requires clear understanding of these factors and the potential mitigating factors or modifications to the contemporary cancer care system. Further research is, therefore, recommended.
Article 2: The Cost of Cancer Care: Part II
This is a review article by Eagle (2012). It explores ideas and programs designed to limit the spiraling cancer care costs whilst mitigating the impact on continued innovations in and sustainable access to high-quality cancer treatments. The specific programs within oncology discussed include critical care pathways, oncology medical homes, and episode-of-care based reimbursement arrangements. Also described are the provisions of the Affordable Care Act aimed at containing health care costs such as the Independent Payment Advisory Board and accountable care organizations. The inherent strengths and weaknesses of these models are also explored. The article also attempts to justify the increased spending on cancer care in the US as compared to other developed nations. The latter countries practice overt rationing via national health technology assessment organizations. However, excessive demands on oncologists to limit spending may conflict with their professional responsibility to their patients. The ultimate worth of increased spending on cancer care is also termed a societal decision. Statistics derived from economic modeling additionally suggest that the increased spending on cancer care in the country is worth.
My perspective is that the two articles are accurate and insightful. The ideas presented in both articles are well informed and supported by current literature. They are well structured and they flow seamlessly into each other. The articles are published in peer-reviewed journals implying that their contents have been highly scrutinized by experts in the field and found accurate. The two articles provide useful insights into the fundamental drivers of cancer care costs at the individual, hospital, and health care system levels. They also explore how the high costs impact on the various stakeholders involved in cancer care. Most importantly, they describe possible solutions to this problem. Of note is that the guidance statement article represents a higher level of evidence than the review article on account of the fact that it was prepared by an expert panel.
- Did the articles have any information that could help you tackle the financial issue in your organization? Mention the points you found useful in a bulleted list.
Information contained in the articles that may help limit spending on cancer medications without compromising on the quality of care include:- Utilization of clinical pathways.
- Reimbursement via episode-based payment models.
- Establishment of an oncology medical home.
- Prioritization of cost-effectiveness during medical decision making.
- Development of educational resources for patients that incorporate information on costs of treatment with other relevant information to support patient decision making.
- Development of clinical support tools that enable oncologists to hold cost discussions with their patients.
- How would you use the information in these articles in the next year in your role as healthcare provider?
I would use the information contained in these articles:
References
Eagle, D. (2012). The cost of cancer care: Part II. Oncology, 26(11).
Meropol, N. J., Schrag, D., Smith, T. J., Mulvey, T. M., Langdon, R. M., Blum, D., Ubel, P. A., & Schnipper, L. E. (2009). Journal of Clinical Oncology, 27, 1-7.
