The High Cost of Cancer Care-2
The Associated Press ran an article about the cost of treating cancer (find it at http://www.deseretnews.com/article/765554241/Cancers-growing-burden-the-...). Excerpts:
Patients, taxpayers and insurers are struggling with the cost of care for many diseases. One of the costliest is cancer.
Patti Tyree was afraid that cancer would steal her future. Instead, the cost of treating it has.
She had hoped to buy a small farm with money inherited from her mother. But co-payments for just one $18,000 round of breast chemotherapy and one shot of a nearly $15,000 blood-boosting drug cost her $2,000.
Bills for other treatments are still coming, and almost half of her $25,000 inheritance is gone.
"I supposedly have pretty good insurance," said Tyree, 57, a recently retired federal worker who lives near Roanoke, Va. "How can anybody afford this?"
The financial strain is showing: Some programs that help people pay their bills have seen a rise in requests, and medical bills are a leading cause of bankruptcies.
"Patients have to pay more for their premiums, more for their co-payments, more for their deductibles. It's become harder to afford what we have, and what we have is becoming not only more costly but also complex," said Dr. Michael Hassett, a cancer specialist and policy researcher at Dana-Farber Cancer Institute in Boston.
Modern treatments have fewer side effects and allow patients to have a greater quality of life than chemotherapy did in the past. But they are far more toxic financially.
Of the nation's 10 most expensive medical conditions, cancer has the highest per-person price. The total cost of treating cancer in the U.S. rose from about $95.5 billion in 2000 to $124.6 billion in 2010, the National Cancer Institute estimates. The true tab is higher — the agency bases its estimates on average costs from 2001-2006, before many expensive treatments came out.
Tyree, the woman from Virginia, said the hospital billed her insurer $14,865 for Neulasta, a shot to boost white blood cells and help her tolerate chemotherapy. Several cancer specialists said Neulasta usually costs less than half that amount, but the charge was $12,000 for Tyree's friend and blog postings by other cancer patients tell similar stories.
The worst part: A much cheaper alternative is available — a different formulation of Neulasta — but many patients aren't offered that option. There's even a cheaper way to get Neulasta, but hospitals make a lot of money giving the shot instead of teaching a patient or a caregiver how to do that.
A recent American Cancer Society survey found that one-quarter of U.S. cancer patients put off getting a test or treatment because of cost, the group's chief medical officer, Dr. Otis Brawley, writes in his new book "How We Do Harm," which discusses costs and argues for more rational use of health care. One out of 5 survey respondents over 65 said they had used all or much of their savings on cancer care.
The burden hits hard on the middle class — people too well off for programs that cover the poor but unable to afford what cancer care often costs.
Dr. Amy Abernethy, director of the cancer care research program at Duke University, did a study of 250 such patients from around the country. Most were women with breast cancer, including Tyree. All but one had insurance, and two-thirds were covered by Medicare. The vast majority also had prescription drug coverage.
Their out-of-pocket expenses averaged $712 a month for doctor visits, medicines, lost wages and travel to appointments. To pay for cancer drugs, half spent less on food and clothes, and 43 percent borrowed money or used credit. Also, 26 percent did not fill a prescription, 22 percent filled part of one and 20 percent took less than prescribed.
Here's where things get sticky. Desperate patients often demand treatments that have a very small chance of helping them. And many doctors feel they have a duty to offer anything that might help, regardless of the cost to insurers and society, said Hassett, the policy researcher from Boston.
An example is the outcry over the government's recent withdrawal of approval of Avastin for breast cancer. Studies showed the drug did not improve survival for most women and there are no biomarkers to identify the few it does help. Many doctors and patients still want access to the drug, and Medicare is still paying for it.
But denying "useless" treatment isn't just about saving money — it's about avoiding harm and false hope, Brawley writes in his book. "A rational system of health care has to have the ability to say no, and to have it stick," he contends.
Dr. Otis Brawley is the chief medical officer for the American Cancer Society. Surely he has a vested interest in finding new and better ways to fund the care of cancer patients. Yet, in his book "How We Do Harm" he points out that we currently pay for 'useless' treatments for cancer patients, which he classifies as harm, both because of false hope and because of excess cost. His conclusion bears repeating: "A rational system of health care has to have the ability to say no, and to have it stick."
Inappropriate care--which is care given where no clinical science supports the intervention--even if well intended or desperately demanded by a dying patient, is quality waste. We know enough about clinical science to say no to many kinds of inappropriate care. We need a societal mechanism which can stand up to the enormous pressures to pay for inappropriate care. These pressures don't primarily come from patients, but from powerful corporations seeking government welfare for their product-be it drug or device. Federal agencies have not shown the backbone necessary to do the right thing when these pressures come to bear. Congress is bought and paid for by the powerful corporate interests.
The Utah Healthcare Initiative proposes the formation of a state based commission to serve this vital function of saying no to inappropriate care. A similar commission is already functioning in the state of Washington. We ask the federal government to get out of the way and let states be the primary innovator in reducing inappropriate care.
Dr. Joe Jarvis