It's one thing when the FDA makes patients wait longer for cancer medicines that have a better chance of working. But once these medicines are approved by the FDA or other medical review agencies around the world, how quickly do patients actually get them?
Not fast enough! After the FDA allows a new cancer medicine to come to market, doctors and patients often don't get to use it right away. That's especially the case for medicines designed to work in a smaller group of patients.
It's not that we don't have a better idea of who those patients are. We do. In fact, the ability to take a genetic fingerprint of our tumors is allowing people with even the most advanced forms of cancer to get matched to a treatment within hours or days, not months or years.
We know that targeted medicines, mostly oral pills, are less toxic than conventional intravenous chemotherapy. And we also know that when people with cancer get these medications, their once-incurable cancers are turned into manageable diseases. In short, the medicines are working. The decline in cancer deaths and increase in life-years saved proves that they are. As the charts below show, fewer people are dying from cancers in which a treatment targets the source of tumor growth.
What about the claim that new medicines for harder-to-treat tumors have only a small benefit? To the contrary, less than 15 years ago, the average life expectancy for people with chronic myeloid leukemia (CML) was just 5 years. Today, someone who receives a diagnosis of CML is likely to live just as long as someone without the illness.
There are more than 60 treatments targeting cancers that are associated with specific genetic mutations, and patients can be tested to determine which of those mutations are present in their cells. But once these tests and therapies get past the FDA, they face a whole new set of hurdles.
Insurance companies and health systems around the world are slow to pay for targeted cancer treatments, if they pay for them at all. In Europe, cancer patients can wait anywhere from a few months to up to 4 years for targeted treatment.
These delays are the result of private health plans and government health systems reviewing new medical technologies for clinical benefit and cost before reimbursement. Often, these reviews consider only how a new medicine or device compares to other treatments in the average patient. From there, an upper limit is placed on how much will be paid. As a result, the reimbursement review becomes another obstacle to getting medicines to patients.
Obstacles to new treatments actually cost patients and society more money. As our Life-Years-Saved Clock shows, adding even a few months to the time it takes to bring new medicine to patients in need can reduce the number life-years saved and the economic value of innovation. A reimbursement review that adds a year to the time it takes to get a new medicine to patients would cost Americans 81 million life-years and $17 trillion over the next 20 years.
Phoenix resident Dick O'Neall received a diagnosis of advanced pancreatic cancer shortly after telling his doctor that he was experiencing a slight discomfort in his ribcage in April 2011. He was given approximately six months to live.
What's the effect of reimbursement hurdles in other countries? In Europe, governments spend time negotiating the cost of a new medicine before they will agree to cover it under their country's health plan. As a result, Europeans wait up to three years longer than Americans for new cancer medicines. Europeans also have had access to more than 30% fewer innovative cancer treatments compared to Americans. Consequently, 5 year survival rates for US cancer patients are 19% higher than they are for those in Europe.
Ironically, while reimbursement hurdles are intended to lower expenses, they actually have the opposite effect. That’s because advances in cancer treatment are saving lives and cutting healthcare costs. In particular, new medicines save money by reducing the need for hospitalization and other medical spending.
For example, between 1998 and 2010, the number of hospitalized CML patients declined by 26%. During the same time period, the number of breast cancer patients hospitalized fell by 39%.
We spend substantially more on hospital care than we do on medications. For every $1 spent on new medicines, we save more than $7 from the cost of illness and ineffective treatments. With $30 billion spent on new cancer medicines in 2009, the savings translates into an additional $210 billion that would have gone to pay for other healthcare services.
Targeted treatments to specific groups of patients reduce the guesswork. The faster we make new personalized cancer therapies available, the longer we will live, and the less it will cost to stay healthy.
The decline in cancer deaths is attributable to the introduction of more personalized and targeted therapies. These treatments are also responsible for reducing the use of more expensive types of care. Instead of creating new barriers between innovation and patients that cost lives and money,
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