As medical oncologists working in chemotherapy utilization management (Oncology Analytics, Inc), my colleagues and I find ourselves daily in the center of the drug-cost maelstrom. While it is encouraging to see that more attention is being paid in the popular and medical press to this “unsustainable” escalation of drug costs, it seems most of the articles (including recently in The ASCO Post) are long on bemoaning the problem and on theorizing what might be done—while medical oncologists are short on creating and implementing actionable strategies to address drug costs. Indeed, the descriptor “unsustainable” has been around for so long that it has become a hackneyed term that by now has lost most of its shock value.
U.S. Food and Drug Administration (FDA) evaluations, National Comprehensive Cancer Network (NCCN) and ASCO guidelines, and enthusiastic reports in The ASCO Post are, for the most part, devoid of cost information about the drugs or regimens referenced. True, ASCO’s “Choosing Wisely” initiative, and the NCCN Journal’s advice to select the most cost-effective approach if all else is equal, represent welcome attempts to focus oncologists’ attention on the cost of care. But where are the numbers, and where are the cost comparisons that deserve to be front-and-center in the minds of patients, physicians, policymakers, and insurers?
I would propose that the The ASCO Post take the lead in calling out the elephant in the room. Though sometimes cost data are not immediately known upon FDA approval of new drugs, in most cases the sticker prices quickly become available and can be added easily in parentheses ($10,000/month is usually fairly accurate!) to the clinical data presented. With The ASCO Post as a trendsetter, how informative it would be if NCCN and ASCO Guidelines, and the Journal of Clinical Oncology, would follow TAP’s lead by similarly and consistently documenting the cost of chemotherapy care.
By not being tuned in to the economics of our profession, and not knowing the downstream financial consequences of every prescription we write, we physicians are complicit in the ultimate undoing of our society’s ability to continue providing the medical marvels now at hand. With the stroke of a pen or the click of a mouse, The ASCO Post’s editorial policy could become a transformative force in finally launching us on a course we should have been on long ago. ■
—William S. Shimp, MD
Plantation, Florida
Disclaimer: This letter represents the views of the author and may not necessarily reflect the views of ASCO.
