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U.S. Spending on Antineoplastic Agents

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Key Points

  • Total expenditures increased from $26.8 billion in 2011 to $42.1 billion in 2016.
  • The highest expenditures for injectable agents in hospitals and clinics from 2011 to 2016 were for rituximab, bevacizumab, and trastuzumab.

In a study reported in the Journal of Oncology Practice, Hong et al found that the U.S. health-care system increased spending on antineoplastic agents from $26.8 billion in 2011 to $42.1 billion in 2016.

The study was a retrospective, cross-sectional analysis of IQVIA (formerly QuintilesIMS) National Sales Perspective data for the period from January 1, 2011, to December 31, 2016. Actual expenditures were totaled by health-care sector and calendar year, with adjustment for medical cost inflation to 2016 dollars. Spending for top-selling injectable antineoplastic agents in the hospital and clinic settings were also assessed.

Total Expenditures

Total expenditures for antineoplastic drugs across all settings increased from $26.8 billion in 2011 to $42.1 billion in 2016. Compared with the immediately preceding year, antineoplastic agent spending increased by 12.2% in 2016; by 15.6% in 2015; by 13.4% in 2014; by 6.3% in 2013; and by 0.4% in 2012.

Across the study period, 96.5% of total expenditures occurred within the settings of clinics, mail-order pharmacies, nonfederal hospitals, and retail pharmacies. In 2016, clinics accounted for $21.1 billion in expenditures, followed by $11.1 billion for mail-order pharmacies, and $6.1 billion for nonfederal hospitals.

Highest Expenditures

The highest expenditures for injectable agents in hospitals and clinics from 2011 to 2016 were for rituximab (Rituxan), bevacizumab (Avastin), and trastuzumab (Herceptin). The highest-expenditure agents in these settings for 2016 were rituximab, bevacizumab, nivolumab (Opdivo), and trastuzumab. The three antineoplastic agents exhibiting the largest growth in expenditures from first full year on the market to 2016 in hospitals and clinics were nivolumab ($0.8 billion in 2015 to $2.6 billion in 2016; 238% increase), pertuzumab (Perjeta; $0.2 billion in 2013 to $0.9 billion in 2016; 80% increase), and pembrolizumab (Keytruda; $0.4 billion in 2015 to $0.7 billion in 2016; 84% increase).

The investigators concluded, “Antineoplastic expenditures are expected to increase because of continuing development and approval of costly targeted cancer therapies. Cost containment and utilization management strategies must be balanced so as not to restrict access or disrupt innovation. Future policies should focus on ensuring safe and appropriate use of antineoplastics while balancing long-term drug costs.”

Glen T. Schumock, PharmD, MBA, PhD, of the University of Illinois at Chicago, is the corresponding author for the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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