What won’t be discussed at ASCO

The NIH identified 273 drugs in a review of FDA oncologic drug approvals. After applying exclusion criteria, 224 cancer drug approvals across 119 individual drugs were analyzed. Across all tumor types, the median annual cost for a course of an anticancer drug was $196,000 (IQR, $170,000-$277,000). As ASCO begins in Chicago, there will be a lot of PR targeted at Wall Street analysts but minimal discussion about the cost of cancer drugs.

The number of new cancer drugs with costs exceeding $200,000 per year has been increasing, accounting for 44% of launches in the past five years, up from 7% in the prior five years, according to the Global Oncology Trends 2023 report from IQVIA Institute for Human Data Science. In the past five years, 79% of oncology launches had annual costs above $100,000, up from 52% in the prior five years. Spending on cancer medicines is growing, rising 4% to $196 billion globally, and is expected to reach $375 billion globally by 2027. In the United States, spending has increased from $58 billion in 2018 to $88 billion in 2022.

For people living with cancer who are on Medicare Part D, the price of prescribed medication plays a pivotal role in whether they can take the treatment directed by their medical team. This is because most people on Medicare are not insulated from high costs — instead, most patients pay a percentage of the overall price of a medicine2. In addition to these percentage payments, also called “coinsurance,” no limit has been placed on how much people pay out-of-pocket each year. As a result, people living with cancer can face annual out-of-pocket costs of more than $16,500.

Cancer drug prices are a leading contributor to growing healthcare expenditure in the United States, with unaffordable drugs’ financial toxicity adversely affecting treatment adherence and patient survival. Previous studies found cancer drug prices are not aligned with the clinical benefit they offer; however, these studies are limited to original drug approvals. After the US Food and Drug Administration approves a drug in its original indication, sponsors submit additional evidence to extend its use to supplemental indications.

Nearly 60% of working-age cancer survivors report facing some financial difficulty. Many patients struggle to afford care and take on debt, with some getting payday loans or running up credit cards. Research shows that cancer alone accounts for some 40% of medical campaigns seeking financial help on GoFundMe.

Many insurers have shifted rising healthcare costs to patients. Some employer-backed plans require patients to pay a percentage of a drug’s cost, which can add up to thousands of dollars. One report found a 15% increase in out-of-pocket costs for privately insured, working-age cancer patients from 2009 to 2016. Patients also foot the bill for transportation, lodging, child care, and parking.

A study published in the medical journal JAMA Internal Medicine found that among cancer drugs that received accelerated approval from the FDA using surrogate endpoints or other measures, only one-fifth improved overall survival rates in later confirmatory trials.

As CNN wrote, “Yet these studies remind us that most new cancer drugs are of marginal benefit at best, despite their immense cost. Rigorous postmarketing studies with meaningful endpoints are expensive, requiring substantive infrastructure and oversight,” they wrote. “One might ask, ‘How can we afford to increase the rigor, and hence the cost, of assessing new cancer therapies after initial approval?’ The real question is: how can we afford not to?”

With ASCO underway today in Chicago, there will be many presentations on new drugs in development and their potential. Still, there needs to be more discussion about the real benefits of these drugs versus their cost. There also needs to be more discussion around whether patients want a treatment because of side effects and quality of life rather than letting the disease run its course.

Finally, the industry needs to discuss the relationship between cancer and obesity. Patients need to be more informed about the risks of poor health and cancer.

ASCO is for investors, not for people.