How to make personalised cancer therapies more cost effective
Researchers reveal some efficient ways
- Date : 15 Mar 2012
- Topic : Personalised medicine
As scientists continue making breakthroughs in personalised cancer treatment, delivering those therapies in the most cost effective manner has become increasingly important. Now researchers at the University of Colorado School of Medicine have identified new ways that could allow more patients to benefit from this revolution in cancer care.
In a paper published in the British Journal of Cancer, health economist Adam Atherly, PhD, of the Colorado School of Public Health and medical oncologist Dr. Ross Camidge, MD, PhD, of the University of Colorado Cancer Center, argue the cost of profiling patients' tumours for specific molecular abnormalities must be considered. This kind of molecular profiling is increasingly being used to determine who would benefit most from a variety of cancer drugs. In addition, many new drugs are now being restricted to cancer patients with specific molecular sub-types of the disease. Many of these initial breakthroughs have happened in lung cancer, but dividing one disease into many different sub-diseases at the molecular level is expected to extend across most of cancer medicine in the next few years.
Very sophisticated molecular tests information to direct patients to the most appropriate targeted therapy
The molecular testing has certainly led to major breakthroughs in the treatment of lung cancer. But if the trend is going to roll these developments out across the world, the oncology community has to understand what this progress costs and how to make it affordable.
Many insurers already consider the cost of a drug and the benefit derived from its use when determining coverage. In their paper, Atherly and Camidge reveal that the cost of testing tumours for an increasing array of specific genetic abnormalities must now also be considered.
According to Atherly, Professor of Health Systems Management and Policy for the Colorado School of Public Health, if every patient is screened with a molecular test to detect something that only occurs in one percent of them – in reality, treating each positive patient should also include the upfront costs of screening the other 99 negative patients.
For example, if a test costs 1000 USD, this means from society's perspective adding 100 000 USD to the costs of treating each of the one in 100 patients that are positive. A cost of the drug itself is a plus. Considering these factors, some organisations may not view a new drug as cost effective even if it works amazingly well for the small percentage who are proven positive by the test.
Who and how to screen for molecular abnormalities
Using recent breakthroughs by the University of Colorado's lung cancer programme to model their data, Atherly and Camidge argue pricing of the molecular profiling tests and policies on who and how to screen for abnormalities should be carefully considered or treatment of many different cancers may be delayed. They suggest two key ways molecular profiling can be made more cost effective. First, clinicians could recommend testing only some patients based on finding certain key clinical factors that increase the chances of a patient having a specific molecular abnormality in their tumour. The downside is that some positive patients may be missed if they don't fit a classical stereotype.
Second, either the cost of the profiling test for each individual molecular abnormality has to be reduced for every patient screened, or tests must be merged so doctors can look for multiple different abnormalities at the same time at a lower combined price.
According to the study authors, if the oncology community doesn't think now about the costs of a personalised cancer care approach and how to address them, breakthroughs in cancer treatment will never achieve their true potential.
Colorado University Cancer Center is the lead site for the USA Lung Cancer Mutation Consortium, the collaboration of 14 of the elite lung cancer programmes. The consortium is profiling ten different molecular abnormalities in lung cancer and pairing them with specific experimental treatments over the next few years.
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