Do oncologists believe new cancer drugs offer good value?
BACKGROUND
Substantial debate centers on the high cost and relative value of new cancer therapies. Oncologists play a pivotal role in treatment decisions, yet it is unclear whether they perceive high-cost new treatments to offer good value or how therapeutic costs factor into their treatment recommendations.


METHODS
We surveyed 139 academic medical oncologists at two academic hospitals in Boston. We asked respondents to provide estimates for the cost and effectiveness of bevacizumab and whether they believed the treatment offered "good value." We also asked respondents to judge how large a gain in life expectancy would justify a hypothetical cancer drug that costs $70,000 a year. Using this information, we calculated implied cost-effectiveness thresholds. Finally, we explored respondents' views on the role of cost in treatment decisions.


RESULTS
Ninety academic oncologists (65%) completed the survey. Seventy-eight percent stated that patients should have access to "effective" care regardless of cost. Implied cost-effectiveness thresholds, derived from the bevacizumab and hypothetical scenarios, averaged roughly $300,000 per quality-adjusted-life-year (QALY). Only 25% of oncologists felt that bevacizumab offered "good value."


CONCLUSIONS
A majority of academic oncologists stated that cost does not influence their clinical practice, nor should it limit access to "effective" care. Yet respondents did not consider all effective drugs to be of good value. Implied cost-effectiveness thresholds were $300,000/QALY--a value higher than the $50,000 standard often cited. A subset of oncologists were sensitive to cost, believing it should factor into clinical decisions. These findings reflect the ongoing controversies within the medical community as expensive new therapies enter the system.
Dana-Faber Cancer Institute/Harvard Medical School, Boston, MA, USA. Enadler2000@mac.com
Eric
E
Nadler
Ben
B
Eckert
Peter J
PJ
Neumann
D000046:Academic Medical Centers; D000328:Adult; D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D000068258:Bevacizumab; D001900:Boston; D003362:Cost-Benefit Analysis; D003657:Decision Making; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008495:Medical Oncology / Q000191:economics*; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab