COSTLIEST CARE THE LESS EFFECTIVE

The most expensive cancer care is the least cost-effective, according to a new analysis of 109 randomized controlled trials.

“The vast majority of our new cancer treatments offer very small incremental improvements in patient outcomes,” Dr. Christopher M. Booth of Queen’s University Cancer Research Institute in Kingston, Ontario, one of the study’s authors, told Reuters Health in a telephone interview. “We have to balance these with the very high costs.”

Concerns about the value of cancer care have led the American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO) to propose frameworks to assess the benefits of new treatments, Dr. Booth and his team note in their report, published online June 2 in The Lancet to coincide with a presentation at the American Society of Clinical Oncology conference.

In their study, they used the ASCO and ESMO frameworks to assess 109 randomized controlled trials of therapies for non-small-cell lung cancer, breast cancer, colorectal cancer and pancreatic cancer.

Using the ASCO framework, which does not have a pre-specified threshold for meaningful benefit, scores ranged from 2 to 77, with a median of 25. Thirty-eight percent of the studies met the ESMO framework’s threshold for a meaningful benefit. Drug cost data was available for 100 of the trials, which found a negative correlation between ASCO benefit score and incremental costs. The treatments with a meaningful benefit based on ESMO thresholds cost a median $2,981, vs. $8,621 for the treatments that did not show a benefit.

Today’s large randomized controlled trials can identify statistically significant benefits with a drug, Dr. Booth noted, but this doesn’t mean these benefits are clinically meaningful. Nevertheless, he added, treatments that do show statistical benefit become part of clinical guidelines.

“The conversation needs to start with the oncologists and the researchers who are designing the trials to think about what benefits would be important to patients and design studies to look for that benefit,” Dr. Booth said.

“As oncologists and researchers we’ve done a very poor job of effectively communicating what a new cancer treatment offers to patients,” he added. “This is something that the clinical community, the research community, and actually the media can try to improve.”

While new treatments are commonly called breakthroughs, Dr. Booth said, “the reality is the vast majority of these so-called breakthroughs do not cure cancer but maybe extend life for a few weeks or a few months at best.”

He and his colleagues conclude: “ASCO-VF and ESMO-MCBS are important tools to quantify value in cancer care, although correlation between the frameworks is mediocre. Delivery of optimal care in a sustainable health system will require oncologists, investigators, and policy makers to reconcile the disconnect between drug costs and clinical benefits.”