If a new cancer drug comes out at a price of $100,000 per person, how many patients likely to benefit will actually get it? How many will drain their entire life savings just to make the insurance co-pays? How many people will go bankrupt to stay alive a few more months? How many people will get overtreated with expensive new meds, when there’s no evidence to support use?
It’s news to nobody that the U.S. healthcare system is an inefficient mess. Yet after all the awareness raised by political and legal wrangling over healthcare the past several years, it’s striking how little real capacity exists for getting answers about cost-effectiveness. This has to change, especially for cancer, the second leading cause of death in the U.S., behind heart disease. Overall healthcare spending has been on an unsustainable trajectory for years, but spending on cancer drugs is growing even faster. It’s on pace to increase by more than 10 percent a year through 2013, according to pharmacy services provider Medco Health Solutions.
Now a small group of researchers in Seattle are planning to tackle these kind of tough questions.
Last week, the Fred Hutchinson Cancer Research Center announced that it is investing some of its own funds to start an institute with a stated goal to “improve the efficiency and effectiveness of cancer prevention, early detection and treatment to reduce the economic and human burdens of cancer.” In a country that’s poured billions into cancer R&D over the past four decades, and has an impressive network of comprehensive cancer centers, the Hutch said it believes this modest initiative will be the first of its kind dedicated to cancer outcomes research.
Lofty as the goal is, the institute, called ICORE, has scraped together a small amount of money to set up a team of about 6-7 faculty members, with additional support staff, who will ask cost-effectiveness questions, according to Scott Ramsey, the health economist leading the institute. Results from its studies will end up being published in peer-reviewed journals, but also put into a free public resource designed to help patients see where the waste is, and where they can find bang for their healthcare buck.
It sounds reasonable, but done well, this effort is bound to ruffle plenty of feathers. The National Institutes of Health focuses mostly on exploration of basic workings of biology, and doesn’t put much grant money to work in cost-effectiveness because “they don’t think quality improvement in cancer is very sexy or research-worthy,” Ramsey says. Hospital networks tend to be leery of anything that might expose their weak underbellies, like disparities in care for people in rural areas or racial and ethnic minorities. Health insurers aren’t exactly champions of transparency in what they do. And drug companies are still mostly allergic to any open and honest public dialogue about whether their products deliver good enough health outcomes to justify their cost.
“There’s a lot of variation in care,” Ramsey says. “That’s potentially a problem for providers and health plans. We’ll have to walk carefully so that others view it as a win-win. Our focus is on improving care for patients.” This won’t be easy. “There will be people threatened by this,” he says.
Every research institute needs money, and ICORE probably won’t get it from many of the deeper pockets in healthcare. The institute hopes to be self-sustaining over time, and to pick up support from foundations, community donors, and agencies like the U.S. Department of Health & Human Services’ Agency for Healthcare Research & Quality (AHRQ), Ramsey says.
While some larger medical practice groups evaluate cost-effectiveness within their networks, nobody is really asking big cost-effectiveness questions in a systematic way, Ramsey says. The institute is starting local in the Seattle area, where Ramsey and his colleagues have
