Peter B. Bach, MD, MAPP, Director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center (Memorial), New York, discussed Dr. Schrag’s study at the ASCO Health Services Research and Quality of Care session.

“Dr. Schrag’s analysis could have been ‘back of the envelope,’ but she spent lots of effort to lay this out. And she found no statistically significant difference, whether in life years or quality-adjusted life years, with two drugs that cost considerably different against dealer’s choice backbone chemotherapy,” he said.

“We are in an era when we have decided on a hierarchy of comparative decision-making in cancer that begins with efficacy, then is followed by toxicity and then cost,” he said.

“Benefits to some extent are constrained by biology, as are harms. But prices and costs? We accept these prices, put them into our cost-effectiveness analysis…. Why not close this loop?” he suggested. “Why treat these prices as immutable? Why would we pay an infinite amount for microscopic benefit? If drugs are equal except for cost, why not just say no to the higher-cost agent?”

Leonard Saltz, MD, Chief of Gastrointestinal Oncology at Memorial, agreed with Dr. Bach in a presentation he delivered at the 2015 ASCO Plenary Session.

“Chemotherapy plus bevacizumab or cetuximab: The outcome is identical, the quality of life is identical, but the cost of the antibody for bevacizumab is less than half that of cetuximab. That doesn’t leave us with two equivalent regimens and dealer’s choice, but one regimen that is clearly the better choice,” Dr. Saltz said. ■

Disclosure: Drs. Bach and Saltz reported no potential conflicts of interest.