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Should Oncologists Care About Cost-Effectiveness Analyses?

written by: GiangNguyen • edited by: Anurag Ghosh • updated: 6/1/2011

It is easy to understand why payers like insurance companies or policy makers like FDA care about economic evaluations. But should physicians care about them too?

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    The primary concerns of oncologists are the health and the survival of their cancer patients. From their perspective, costs should not play role in the process of recommending treatments to the patients. However, in a real world, economic factors have significant effects on both patients and physicians. Cost-related factors such as insurance and socioeconomic factors significantly influence the rates of diagnosis and treatment of cancer. Ya-Chen Tina Shih and Michael T. Halpern (2008) listed several reasons why oncologists should read reports on cost-effectiveness analyses.

    First, patients often need to pay for part of their medications. In recent years, with the advance of biotechnology, several biotech products (known as biologics) have been shown to improve survival of cancer patients. However, these biologics are extremely expensive, typically in the range of $30-50,000 or more. For instance, cetuximab, a new colorectal cancer drug, costs $50,000 for weekly treatment. This is a significant increase in comparison to fluorouracil/leucovorin, which are typically used for colorectal cancer patients at the price of $100 a day. Furthermore, in many cases, the improvements of cetuximab over fluorouracil/leucovorin are not clearly proven. Thus, oncologists should discuss the cost of each treatment choice and their benefits with the patients since many patients will not be able to afford the expensive treatments and may opt for drugs that are less expensive.

    Second, cost-effectiveness analyses provide a natural starting point for physicians, decision makers and patients to talk about cost and benefits of a health care intervention. They might disagree on the assumptions or on how costs being calculated, but economic evaluations provide them with a platform for developing communications with each other.

    Third, cost-effectiveness analyses allow oncologists to prioritize. Oncologists can decide on whether to spend money to screen early cancers in people or to invest in a drug that only cures a few number of advanced cancers.

    Fourth, since cost-effectiveness analyses will become the basics for many decisions, oncologists should understand and get involved in such analyses. Otherwise, decisions will be made without their participation. Oncologists also need to understand the limitations of cost-effectiveness analyses. Many cost-effectiveness analyses are not conducted properly and do not accurately reflect the state-of-the-art understanding of the conditions and the treatments. The involvement of oncologists in the process of determining how to calculate costs and benefits properly will benefit cancer patients greatly.


    Economic Evaluations of Medical Care Interventions for Cancer Patients: How, Why, and What Does it Mean? CA Cancer J Clin. ;58 (4):231-44 18596196