New Ideas to Control Spending

Cancer is a frightening disease which has become all too common, especially as our population ages.  It also is expensive, accounting for around $125 billion in health spending.  Much of this is driven by very costly drugs.  The rate of growth in spending is high and places a heavy burden on patients, who usually have significant cost-sharing for treatment expenses.  An article in the New England Journal of Medicine discusses ways that medical oncologists could take up the challenge of keeping spending under control while not compromising the quality of care.   (NEJM Article)

Five primary ideas are listed.  The first is to limit ongoing surveillance testing with biomarkers and imaging.  Research shows no benefit to these practices, but they produce substantial physician and lab revenues.  The second is to be more sparing in the use of combination drug therapies, which studies again have shown to be of little benefit compared to sequential monotherapy.  Patients also tend to have fewer side effects during monotherapies.  The third is to stop using chemotherapy with patients who have low functional status and little chance of cure or even extended survival.

The fourth recommendation is to stop using colony-stimulating factors so widely, as they are expensive and have little effect on ultimate outcomes.  Doctors, however, make a lot of money administering these drugs.  The fifth suggestion is to pay oncologists more for cognitive services and care management, especially for management according to established care pathways.  The article represents a bold attempt by physicians to recommend significant changes in practice; an attempt which should be made by every specialty and which policymakers should find ways to encourage and implement.  This doctor-driven practice reform would be the best way to control spending.