Expensive Chemotherapeutic Drug Costs Influence Treatment Decisions by Nearly One Quarter of Medical Oncologists

In a survey of 167 medical oncologists reported in the Journal of Clinical Oncology, 42 percent of medical oncologists said they regularly raise the issues of cost when discussing treatment options with patients. Twenty-three percent said that the cost of chemotherapeutic drugs influences their treatment decision and 16 percent said that omit discussions of expensive treatments when they know that the patients cannot afford it. Based on these results, the American Society of Clinical Oncology composed a taskforce to help guide physicians in discussing the cost of treatment with their patients.

In 2007 the cost of cancer care alone reached 89 billion dollars, up from 72 billion dollars in 2004. Of this cost, nearly 70 billion dollars are spent for chemotherapeutic drugs or drugs to support cycles of chemotherapy.

The monthly cost of cancer drugs, as estimated by the manufacturers, is listed below:

DRUG	MANUFACTURER	MONTHLY COST
Avastin	Genentech	7,700 dollars
Revlamid	Celgene	6,000 dollars
Nexivar	Bayer	5,000 dollars
Sutent	Phizer	4,400 dollars
Herceptin	Genentech	3,300 dollars
Erbitux	Imclone	3,000 dollars

Through the 1990s medical oncologists obtained a significant portion of their income from office delivery of chemotherapeutic drugs because of the substantial mark up allowed on these agents. The 2003 Medicare Modernization Act however, resulted in major limitations in payment for intravenous chemotherapy agents (only 6 percent markup). In recognition of the decrease in CMS allowed a 3 fold increase in the reimbursement for first hour of chemotherapy delivery.

Medical oncologists median income in 2006 and 2007 was $360, 000 according to Medical Group Management Association, a professional society of physician practice managers based in Denver. Medical oncologists were able to maintain their income due to the increase in reimbursement in the first hour of chemotherapy, as well as the substantially higher costs of chemotherapeutic drugs yielding a smaller margin by percentage, but a higher number of total dollars collected. Such compensation, however, may only be temporary. In government run healthcare systems in Europe, public policy has determined that some of the more expensive drugs have only a marginal benefit and will, therefore, not be authorized. For example, in Britain and Scotland, Oxaliplatin is not approved for treatment of metastatic colorectal cancer. This drug along with Avastin has increased the cost of treating patients with metastatic colorectal cancer to nearly 100,000 dollars per year. Will policy makers in the US follow suit?

Radiation therapy, by contrast, cures approximately half of patients treated but costs Medicare six billion dollars per year. While it is not inexpensive, it should be emphasized to payers and the public that radiation therapy is money well spent.

Paul J. Schilling, MD, FACRO
Community Cancer Center of North Florida, Gainesville Florida