What’s missing from ASH?

SUMMARY: ASH is well underway in Orlando and there has been a lot of great news on new drug combinations to fight cancer. However, the one subject that seems to be missing is the high cost of cancer drugs.

Cancer patients are 2.5 times more likely to file for bankruptcy after they are diagnosed, according to the Fred Hutchinson Cancer Research Center, based in Seattle. Americans spend more on pharmaceuticals per capita than any other country in the Organization for Economic Co-operation and Development (O.E.C.D.).

In the past 10 years, the average premium for job-based health insurance that covers a family has risen 54%, to $20,756. Moreover, the amount of that premium workers pay for family coverage has increased 71%, to $6,015.

During that same decade, the share of workers whose health plans carry deductibles requiring them to pay hundreds or thousands of dollars in out-of-pocket costs before their insurance coverage kicks in has increased from 63% to 82%. The size of the average deductible has grown from $826 to $1,655.

For patients and their families, the costs associated with direct cancer care are staggering.  In 2014 cancer patients paid nearly $4 billion out-of-pocket for cancer treatments. Cancer also represents a significant proportion of total U.S. health care spending.  Roughly $87.8 billion was spent in 2014 in the U.S. on cancer-related health care.   These costs were paid by employers, insurance companies, and taxpayer-funded public programs like Medicare and Medicaid, as well as by cancer patients and their families.

The total annual cost of cancer care in the United States (including direct and indirect costs) has been estimated at more than $96 billion. Although third-party payers have led the effort to reduce these costs, such high expenditures must concern society as a whole, since money spent on cancer care, whether through insurance premiums, taxes to support Medicare, or payouts from family savings, could be used for other purposes. In the future, attention may be shifted to more cost-effective strategies, including greater prevention efforts and the development of better diagnostic tools to permit early detection. Improved diagnosis, however, presents an anomaly in that with earlier detection, survival is greater but the overall direct treatment costs are higher. This is why when making decisions about the allocation of medical resources, the indirect costs of morbidity and mortality (which are reduced with early diagnosis) must be considered as well as the direct cost.


One doctor Tweeted “are there any sessions on the cost of drugs here at ASH?”. Unfortunately, there weren’t many if any. ASH has become more about a company’s financial outlook as much as medical data.

For too many patients and caregivers, a diagnosis of cancer can mean bankruptcy as well as the psychological burden of fighting a deadly disease. It’s time to think more about a patient’s ability to afford breakthrough treatments as well as the data around new drugs.