Trendspotter: Docs Willing to Consider Cost Effectiveness in Care

A recent survey of U.S. and Canadian oncologists reaches two non-intuitive conclusions: First, the majority of oncologists see nothing wrong in considering the cost-effectiveness of drugs and other cancer treatments; and second, there are fewer differences between the attitudes of U.S. and Canadian doctors on this issue than one might suppose, considering how different the two countries’ health systems are.

Here are some of the survey’s findings:

• Eighty-four percent of U.S. oncologists and 80 percent of their Canadian colleagues agree that patients’ out-of-pocket costs influence their treatment recommendations. (While all Canadians have access to cancer care, they must pay for certain drugs themselves.) 

• Sixty-seven percent of U.S. and 52 percent of Canadian oncologists say that cancer patients should have access to effective treatments, regardless of their cost.

• Fifty-eight percent of U.S. and 75 percent of Canadian oncologists agree that “every patient should have access to effective cancer treatments only if the treatments provide ‘good value for money’ or are cost effective.”

• Fifty-seven percent of U.S. and 68 percent of Canadian oncologists want Medicare to control the price of cancer drugs. (Canada’s universal healthcare system is called Medicare.)

• Eighty percent of U.S. and 69 percent of Canadian oncologists think there should be more use of cost-effectiveness data in coverage and payment decisions.

• Seventy-nine percent of U.S. and 85 percent of Canadian oncologists want more government research on the comparative effectiveness of cancer drugs.
 

There’s a yawning chasm between U.S. doctors’ attitudes and those of the politicians who debated the Affordable Care Act, which includes funding for comparative effectiveness (CE) research. Faced with strong opposition from some healthcare industry groups, congressional Democrats added language that barred Medicare from using CE research in coverage decisions. While focused on comparative effectiveness studies, this decision was grounded in a long history of opposition in the U.S. to using cost effectiveness in medical decisions. Yet here we have a study showing that 80 percent of U.S oncologists believe it’s acceptable to do that; a majority also would restrict access to effective cancer treatments if they didn’t provide value for the money.

Some physicians, in contrast, think that CE research is a waste of money. Dr. Richard Leff suggests in a recent blog that instead of comparing the effectiveness of current treatments, we should focus on research to develop new treatment approaches. He writes:

"Research to compare similar treatments could 'use up' thousands of patients who might otherwise be considered for participation in studies of newly developing therapies. In addition, the energy and resources that are currently devoted to developing studies that test the efficacy of new drugs and technologies are not limitless and might be taxed by CE research."

Leff is right that CE research could drain some money away from studies that might advance medical science. But focusing only on new drugs and treatments, without doing comparative studies to determine which current interventions are the most effective, is one reason why our healthcare system is in crisis. And, although self-interested parties - such as drug companies and device makers - would like us to think that it’s horrible to consider cost in treating patients, most of the surveyed oncologists agree that out-of-pocket costs (and presumably, a patient’s financial situation) influence their choice of interventions. It doesn’t make much sense to recommend that a patient get a treatment that he or she can’t afford and that no one else is willing to pay for.

That brings up the comparison between U.S. and Canadian attitudes. Fewer Canadian than U.S. oncologists think there should be more use of cost-effectiveness data in coverage and payment decisions; that’s because Canada already makes use of such information to some extent. But in both countries, doctors say, there is a need for much more CE research. So whether doctors are working in a single-payer system or a mixed public/private system, the problem is that there isn’t enough good data on which healthcare interventions work best.

Physicians in both the U.S. and Canada understand that healthcare resources are limited and that access to them will decline unless they’re used wisely. But it’s hard to convince patients of that. Political leaders should join with doctors to make this case, rather than frighten people with loose talk about healthcare “rationing.”