free full text

Annual direct costs for cancer care are projected to rise — from $104 billion in 20061 to over $173 billion in 2020 and beyond.2 This increase has been driven by a dramatic rise in both the cost of therapy3 and the extent of care.4 In the United States, the sales of anticancer drugs are now second only to those of drugs for heart disease, and 70% of these sales come from products introduced in the past 10 years. Most new molecules are priced at $5,000 per month or more,5 and in many cases the cost-effectiveness ratios far exceed commonly accepted thresholds.6 This trend is not sustainable.....

....CONCLUSIONS Like the members of Congress who promised to cut the federal budget but now do not want to reduce funding for Medicare, Social Security, or the Department of Defense, we as a society face tough decisions. Some areas of oncology — for example, clinical trials and curative as well as proven adjuvant treatments — should be off limits when it comes to primary cost considerations. We understand that this will be extraordinarily difficult, since one person’s cost constraint is another person’s perceived lifesaving benefit and yet another’s income. We should also recognize that patients facing death have a very different and important perspective on risk. However, we are convinced that we can take these steps if we work together as consumers, advocates, professional societies, and payers. There really is no other way. Our intention is to encourage other specialties to do the same and flatten the cost curve so that patients can continue to get the best new therapies.