HER2 Support Group Forums - View Single Post - Lessons From The Mammography Screening Controversy

gdpawel · 10-29-2010, 06:41 PM

It's been difficult for the Medicare program to contol the substantial costs of cancer drugs. In an issue of the New England Journal of Medicine, an article by Dr. Peter Bach stated that the costs to Medicare of injectable cancer drugs given in doctors' offices increased from $3 billion in 1997 to $11 billion in 2004, an increase of 267% at a time when the costs for the entire Medicare program increased 47%.

It also stated that there was a huge reduction in Medicare expenses that occurred when the off-label use of ESAs (drugs for anemia-related issues) was found to actually cause harm to patients. The drugs were proven to be over-used and the net result of expose was that use of these drugs quickly dropped and the costs to Medicare dropped from over $1 billion a year to just $200 million.

In 2003, in the political payback deal of the century, Congress guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs.

Dr. Bach stated ways that the Medicare program could control costs. One of the ways the Medicare program could control costs is to fund a comparative-effectiveness program to assess whether or not treatments are really better than older treatments. Decisions can be made about what cancer treatments patients can actually afford.

Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it.

Comparative-effectiveness research can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Doctors will still have the ultimate decision, along with the patient.

I've heard many times, in regard to health care reform, that the government is going to ration our health care with comparative effectiveness research (CER).

Let's take this issue with regard to NCCN and ASCO guidelines and see how fraternal organizations enlist rationing.

ASCO has issued guidelines on how physicians should discuss cost of treatment options with patients. I've never heard that ASCO has been knighted a regulatory agency. Some experts warn that their guidelines could raise costs even further, thus limiting access to cancer patients.

Allen Lichter of ASCO has said "Cancer sticker shock is hitting hard now, the cost of treating cancer is rising by 15% annually. Affordable treatment options are a particular issue for patients with incurable forms of cancer who are looking for both the longest possible survival and the best quality of life."

One of ASCO's suggestions is for oncologists to consider the cost, essentially as another side effect, when choosing a treatment. According to MSK's Leonard Saltz and other physicians at attendance at one of NCCN's meetings, many physicians do not know the cost of certain treatments because they are not included in treatment "standards." "If we can do it just as well less expensively, I think doctors should know that and be able to make a decision," Saltz said.

Why is our government being accused of health care rationing when others have suggested it themselves?

10-29-2010, 06:41 PM	#3
gdpawel Senior Member Join Date: Aug 2006 Location: Pennsylvania Posts: 1,080	It's been difficult for the Medicare program to contol the substantial costs of cancer drugs. In an issue of the New England Journal of Medicine, an article by Dr. Peter Bach stated that the costs to Medicare of injectable cancer drugs given in doctors' offices increased from $3 billion in 1997 to $11 billion in 2004, an increase of 267% at a time when the costs for the entire Medicare program increased 47%. It also stated that there was a huge reduction in Medicare expenses that occurred when the off-label use of ESAs (drugs for anemia-related issues) was found to actually cause harm to patients. The drugs were proven to be over-used and the net result of expose was that use of these drugs quickly dropped and the costs to Medicare dropped from over $1 billion a year to just $200 million. In 2003, in the political payback deal of the century, Congress guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs. Dr. Bach stated ways that the Medicare program could control costs. One of the ways the Medicare program could control costs is to fund a comparative-effectiveness program to assess whether or not treatments are really better than older treatments. Decisions can be made about what cancer treatments patients can actually afford. Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Comparative-effectiveness research can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Doctors will still have the ultimate decision, along with the patient. I've heard many times, in regard to health care reform, that the government is going to ration our health care with comparative effectiveness research (CER). Let's take this issue with regard to NCCN and ASCO guidelines and see how fraternal organizations enlist rationing. ASCO has issued guidelines on how physicians should discuss cost of treatment options with patients. I've never heard that ASCO has been knighted a regulatory agency. Some experts warn that their guidelines could raise costs even further, thus limiting access to cancer patients. Allen Lichter of ASCO has said "Cancer sticker shock is hitting hard now, the cost of treating cancer is rising by 15% annually. Affordable treatment options are a particular issue for patients with incurable forms of cancer who are looking for both the longest possible survival and the best quality of life." One of ASCO's suggestions is for oncologists to consider the cost, essentially as another side effect, when choosing a treatment. According to MSK's Leonard Saltz and other physicians at attendance at one of NCCN's meetings, many physicians do not know the cost of certain treatments because they are not included in treatment "standards." "If we can do it just as well less expensively, I think doctors should know that and be able to make a decision," Saltz said. Why is our government being accused of health care rationing when others have suggested it themselves?