Can Personalized Cancer Become Affordable?

Cancer economics model needs to be changed

(RxWiki News) Personalized treatment is the new cancer frontier. The DNA of a tumor is analyzed, and a specific drug is used to target the mutant gene(s). It's a great concept, but exceedingly expensive to deliver. Or is it?

Science is hurtling into never before seen territory, with new molecular abnormalities constantly being identified as markers of cancer.

And while these advances are exciting, the economics model for applying personalized cancer treatment needs to be re-engineered so that more patients can access these advances.

"Find out if your tumor will be screened."

Adam Atherly, Ph.D., of the Colorado School of Public Health (CSPH) and medical oncologist D. Ross Camidge, M.D., Ph.D., of the University of Colorado Cancer Center, say that the costs of screening need to be taken into consideration and modified.

The researchers used data on new lung cancer drugs used at the University of Colorado to study overall cost-effectiveness of personalized cancer treatment.

Dr. Camidge describes the dilemma: "In recent years, we have championed the practice of performing very sophisticated molecular tests on the tumors of every lung cancer patient we see. We then use this information to direct patients to the most appropriate targeted therapy for their cancer," said Camidge, CU Cancer Center investigator and director of the thoracic oncology clinical program at University of Colorado Hospital (UCH).

"The most expensive part of personalized cancer treatment can be the screening if many people who are tested turn out to be negative," says Dr. Camidge.

"The cost of finding rare positive people who have the specific molecular abnormalities can sometimes predominate in the overall cost effectiveness calculation more than the cost of the drugs themselves," Dr. Camidge tells dailyRx.

Atherly, professor of health systems management and policy for the Colorado School of Public Health, says: "If you screen every patient with a molecular test that costs $1,000 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."

He goes on to explain "this means from society's perspective you have to add $100,000 to the costs of treating each of the one in 100 patients that are positive.

So the solution, according to these researchers is either to bring down the cost of the screening to find each positive patient or to choose the right patients to test, such that the frequency of positive becomes higher in the preselected population.

Dr. Camidge says, "In terms of lower the cost per positive, one of the most promising ways is instead of testing for one abnormality, we need to bundle together tests for 15 or more different relevant abnormalities. And the increased cost of this expanded testing needs to be fractional not multiplicative."

That is, the new test for multiple abnormalities would only cost say 50 percent more than the original test looking at one abnormality. So in the case of the $1,000 test, a test looking for 10 differences would cost $1,500 - not $15,000. If you get 10 times as many positives, even if they are in different genes, the cost per positive is dramatically reduced.

Alternatively, Dr. Camidge says some policies have been proposed in which clinicians recommend only certain patients for tumor profiling. These patients should display various clinical factors that would suggest they are more likely to have the abnormality being screened for, for example a history of little or no smoking.

“This can also lower the cost per positive as the population screened has been enriched,” says Dr. Camidge. “But the real down side is that patients could be missed if they don’t fit the given stereotype. So while this may at times be an economic necessity, medically it is not an attractive option at all.”

The researchers add many insurers and health systems around the world evaluate the cost of a drug and the benefit it delivers. But now the cost of testing also needs to be added to the equation.

"We believe the only way to beat cancer is moving away from the one-size-fits-all model," said Dr. Camidge.

"To do this we must treat every person as an individual. But if we don't think now about the costs of this approach and how to address them, these breakthroughs will never achieve their true potential," he concluded.

The paper was published in the British Journal of Cancer.

No financial conflicts of interest were declared.

Review Date: 
March 16, 2012