title: Continental Divide? The attitudes of US and Canadian oncologists on the costs, cost-effectiveness, and health policies associated with new cancer drugs.
abstract: OBJECTIVE
  Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy.
  
  
  METHODS
  Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared.
  
  
  RESULTS
  Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value.
  
  
  CONCLUSIONS
  Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.
authors.affiliation: Sunnybrook Odette Cancer Center, 2075 Bayview Ave, Toronto, Ontario, Canada. scott.berry@sunnybrook.ca
authors.forename: Scott R
authors.initials: SR
authors.lastname: Berry
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: William K
authors.initials: WK
authors.lastname: Evans
authors.forename: Eric
authors.initials: E
authors.lastname: Nadler
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Strevel
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics*; D001291:Attitude of Health Personnel; D002170:Canada; D016009:Chi-Square Distribution; D017047:Cost Sharing / Q000191:economics / Q000331:legislation & jurisprudence; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D015507:Drugs, Investigational / Q000191:economics*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000191:economics* / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence; D008297:Male; D008495:Medical Oncology / Q000191:economics* / Q000331:legislation & jurisprudence; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D015507:Drugs, Investigational