Cost issues in new disease-modifying treatments for advanced cancer: in-depth interviews with physicians.
BACKGROUND
The high costs of new disease-modifying, but non-curative, treatments in advanced cancer are increasingly regarded as problematic. Little is known about oncologists' beliefs regarding their ethical obligations for cost considerations about these types of treatments.


METHODS
This study used in-depth interviews to explore how physicians in The Netherlands view their role regarding the cost of potentially beneficial but expensive drugs, especially for new disease-modifying treatments in advanced cancer. Thirty-six physicians, 19 physicians caring for patients with advanced cancer and 17 physicians participating in four national oncology guideline committees, were interviewed.


RESULTS
Physicians identified cost considerations on three levels: individual patient care, hospital policies and national guideline development. Generally, physicians were reluctant to consider costs in individual patient care, believing this compromised their ethical obligations. They did consider costs relevant at the level of hospital policies regarding coverage for drugs. They were divided regarding the role of cost considerations in national practice guideline development.


CONCLUSIONS
The distinctive levels of decision-making were understood to be morally relevant as physicians separated their role as direct care provider from that of taking part in decisions about coverage. Because of the fundamental tension between the physician obligation to act in the best interest of the individual patient, the vulnerability of having a life-threatening illness and the inevitability of sharing resources in modern health care, cost considerations will always be problematic for physicians. The roles physicians play at different levels, especially at the levels of hospital policies and national practice guidelines, should further be developed and explicated.
de Kort
Susanne J
SJ
Department of General Practice, Academic Medical Center, University of Amsterdam, #J2-225, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands. s.j.dekort@amc.uva.nl
Kenny
Nuala
N
van Dijk
Paul
P
Gevers
Sjef
S
Richel
Dick J
DJ
Willems
Dick L
DL
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003657:Decision Making; D017048:Health Care Costs; D006801:Humans; D007407:Interviews as Topic; D008495:Medical Oncology; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011788:Quality of Life
D000970:Antineoplastic Agents