IMS Report on Cancer Care

Cancer is one of the most feared diseases and one of the most expensive to treat, especially with the burgeoning pipeline of new specialty drugs.  And while cancer was once primarily an acute episode disease, in which the patient either died in a relatively short period of time or was cured or went into long-term remission, the new treatments mean it is often akin to a chronic disease, with a high level of spending over multiple years.  An IMS report details the changes in cancer care and what the implications of those changes may be.   (IMS Report)   Global spending on oncology drugs in 2013 was $91 billion, with the US being the largest single market at $37.2 billion.  Growth rates have been about 5.8% a year for the last decade.  Pricing in the US, even at the launch of a new drug is often significantly higher than that in other countries.  Cancer incidence has been rising around the world, with different types being more prevalent in the developed versus developing world.  Some of this increase may be due to better screening and diagnosis.  Survival has increased over the last two decades, with some of this due to better treatments.  Oncology is the leading drug cost category in terms of spending in most developed countries.  Cytotoxic drug share has declined, with targeted and immune therapies picking up share.  The drug pipeline for oncology is guide large, as many as 2000 compounds and many of the recently approved drugs are for cancer.  In the US, many of these drugs are getting breakthrough therapy designation from the FDA, which accelerates approval.

Drugs in the pipeline are aimed not only at cancers affecting large numbers of people, but those for smaller incidence cancers, which may account for some of the high pricing.  The most drug development is occurring where the science has laid a good foundation with targets and biomarkers.  The cost of treating cancer has risen dramatically with the new agents, with an average cost of $10,000 a month for these drugs versus about $5,000 a decade ago.  While many of these drugs are better, the average survival increase is typically measured only in months, so the cost/benefit ratio is fairly high.  Oncology medical groups and others are attempting to set goals for how much it is worth to get an additional month of survival.  In the US, there has been significant consolidation among oncologists and acquisitions of practices by hospitals.  This has led to a shifting in treatment location to more expensive hospital outpatient settings, which cost on average twice as much as a physician office, which raises patient cost-sharing and has a negative impact on uptake and adherence to therapy.  The report has a great deal of useful information.  New cancer drugs have the potential  to provide great physical and emotional relief to patients, but at least in the US, the costs need much better management if the system is not to be overwhelmed.