Despite the promise of precision oncology, the cost-effectiveness of targeted treatments remains open to debate. According to Aakash Desai, MD, MPH, there is an urgent need for drug-pricing reform, given the average expenditure of Medicare Part D.

Aakash Desai, MD, MPH

An analysis of the Medicare database presented during the 2021 ASCO Quality Care Symposium has found that the mean annual growth rates in costs for modern oral precision-driven cancer therapeutic classes mostly outpaced the consumer price index as well as the average inflation rate between 2015 and 2019.¹

“As out-of-pocket costs for patients with cancer continue to trend upward, we need increased advocacy efforts from oncologists, patient advocates, and others to ensure precision therapeutics remain an attainable and sustainable goal,” said Dr. Desai, Hematology and Medical Oncology Fellow, Mayo Clinic, -Rochester, Minnesota. “The promise of precision oncology will fail if we fail to bring the right drugs to the right patient at the right time without it being at the right price.”

Study Methods

According to Dr. Desai, despite debates about the cost-effectiveness of targeted treatments, the increase in the price of oral targeted anticancer treatments used for common malignancies has not been systemically evaluated. Thus, Dr. Desai and colleagues sought to report the patterns in price changes between 2015 and 2019 for multiple oral anticancer medications for common solid tumors.

With the Medicare Part B provider utilization and payment database, the researchers analyzed and extracted drug prices, including generic and brand medications, for commonly used targeted oral anticancer agents for lung, breast, and prostate cancers. The study’s primary outcome was the correlation of average change in Medicare spending per dosage unit among the multiple medications within each specific medication drug class. The researchers also calculated compound annual growth rate for medication costs within each class and compared it with the inflation rate and the consumer price index, a measure of the average change over time in the prices of consumer items.

Drug Expenditures Outpacing Inflation, Consumer Prices

The study included six EGFR inhibitors, five ALK inhibitors, two BRAF inhibitors, three hormonal agents, three CDK4/6 inhibitors, two PARP inhibitors, and seven antiandrogen agents. Although generics such as erlotinib and abiraterone were included, said Dr. Desai, most drugs were brand medications. Except for antiandrogens, the median correlation coefficient values for drugs within each class were very close to 1, which means there was a direct correlation in price trends.

“The antihormonal agents or antiandrogens did not have directly correlated prices, but that could also be because some had generics and some have been on the market for a long time,” Dr. Desai explained. “All other drug classes showed strong linear association in price increase between two drugs within the same class.”

Between 2015 and 2019, the median compound annual growth rates in costs were 4.56% for EGFR inhibitors, 6.40% for ALK inhibitors, 2.58% for BRAF inhibitors, 5.48% for hormonal agents, 5.21% for CDK4/6 inhibitors, 27.29% for PARP inhibitors, and 34.8% for antiandrogen agents. Conversely, over this same 5-year period, the inflation rate and consumer price index were 1.7% and 2.1%, respectively.

“For most of these drug classes, the growth rates outpaced the annual inflation rate and consumer price index for prescription drugs,” said Dr. Desai. “Most of them were at least twice the consumer price index, whereas PARP inhibitors and antiandrogens had astronomical median compound annual growth rates.”

“Ultimately, increase in cost within the same class should always be weighed against the incremental clinical benefit provided for patients,” Dr. Desai continued. “For most classes, despite there being multiple agents, the rise in drug expenditures correlated closely, calling into question the true value of within-class competition.”

Dr. Desai acknowledged that expenditures reported in the Medicare database do not directly reflect out-of-pocket expenses for patients but said that increasing Medicare prices indirectly translate into higher out-of-pocket costs for patients downstream.

The researchers are planning to analyze out-of-pocket costs for multiple medications, including oral targeted therapies.

“We are all very excited by the precision oncology boom, but I think we also have to keep in mind that it’s not just the treatments for our patients that are important but also the costs,” Dr. Desai concluded. 

DISCLOSURE: Dr. Desai reported no conflicts of interest.

REFERENCE

1. Desai A, Jensen C, Scheckel C, et al: The economic cost and sustainability of the precision oncology promise. 2021 ASCO Quality Care Symposium. Abstract 7. Presented September 24, 2021.