Health-System Perspectives on Oncology Market Access in 2018

Cancer care continues to be a top health priority and driver for health care costs. According to the National Cancer Institute, there were more than 1.6 million new cases of cancer in 2016 in the United States, with an estimated 600,000 deaths. Breast, lung, prostate, and colorectal cancer continue to account for most cases. With continued advances in, and access to, new therapies, it is estimated that the number of people living with cancer in this country will increase to nearly 19 million by 2024.

National costs associated with cancer care could reach more than $20 billion by 2020.1 With increased life spans possible for so many patients, there is an ongoing shift toward many cancer types being treated as maintenance diseases. This shift can put a significant financial burden not only on patients, but also payers and providers within the health care industry. Data from the Surveillance, Epidemiology, and End Results Cancer Statistics Review indicate that death rates declined by 1.4% in women and 1.8% in men from 2004 to 2013.2 Although reductions in smoking have had a positive impact, other risk factors, including obesity and an aging population, will continue to increase incidence rates.

Pharmaceutical research and development continue to focus on novel and innovative therapies, as evidenced by the oncology market space growing to more than $107 billion annually. Immunotherapy drugs have quickly become a major player in the space, with treatments such as Opdivo and Keytruda having numerous indications, with very specific populations showing a response. In addition to these checkpoint inhibitors, chimeric antigen receptor T-cell therapies have recently emerged for various types of cancer.3 H

owever, with these therapeutic advances also comes a high price tag for those involved in treatment. The leukemia drug Kymriah, for instance, costs approximately $475,000 per year. Nearly half of patients administered this therapy develop a condition known as a “cytokine storm,” which results in a dangerous immune response with high fevers and low blood pressure. However, Kymriah manufacturer Novartis has stood behind the value of its drug. The company has indicated it will only charge for the drug if the patient goes into remission within the first month.4 This type of pricing model may be attractive to many payers due to the long-term costs associated with cancer treatment, as it requires the manufacturer to have skin in the game.

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