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Kathy was diagnosed with advanced adenocarcinoma of the left upper lobe metastatic to the bones in January 2016. Within 5 weeks ofer diagnosis, she had low-dose lung computed tomography (CT), a second chest CT scan to confirm the findings, pulmonary function tests, a lung needle biopsy, a positron emission tomography (PET)/CT scan, several blood tests, and next-generation sequencing searching for actionable genetic alterations and was seen by a medical oncologist. Kathy was deemed not a candidate for targeted therapy or immunotherapy up front and began chemotherapy in March 2016. Response to chemotherapy was evaluated with serial CT scans. In May, Kathy was found to have progression of her disease during an emergency room visit and started second-line immunotherapy in June at her doctor’s office. The immunotherapy resulted in stable disease and maintained her quality of life, so Kathy continued the treatment and monitoring through the end of the year.
Kathy bought an individual health insurance plan, which started in January 2016, through her state’s marketplace. The premium for her plan was $537 per month, but she qualified for tax credits, which helped reduce these costs. Kathy ended up paying $272 per month in premiums. Kathy’s highest costs were in January ($3,678) and February ($3,716), when she had multiple diagnostic tests and paid 40% percent co-insurance for imaging tests and scans, in addition to premiums. She met her maximum out-of-pocket limit in February; after that, no cost sharing was required as long as she paid her premiums and received all her care in network. At the end of her plan year, Kathy had paid a total of $3,264 in premiums and $6,850 in cost sharing for her cancer care. The total health care costs for Kathy’s lung cancer treatment in 2016 were $210,067. Kathy’s insurance plan paid the vast majority of these costs—$203,217. (Adapted from an American Cancer Society Cancer Action Network Report: Singleterry J. The Cost of Cancer: Addressing Patient Costs.1)
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Learning Objectives
What are the financial consequences of the improvement in therapies and lung cancer outcomes?
What are the factors driving the rising cost of lung cancer care?
What is the impact of rising costs on patients and society?
What are the instruments and strategies used to evaluate the value of any given lung cancer therapy?
What are the current efforts to address these rising costs of lung cancer care?
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Lung cancer is the leading cause of cancer-related mortality worldwide.2,3 The development of new therapies for lung cancer (targeted therapies and immunotherapy), along with an increase in prevention efforts, has resulted in a reduction in the incidence and mortality of lung cancer in some populations (eg, men in Northern Europe and North America). In other groups, however, the incidence and mortality in women have reportedly increased (women in a large part of Europe, South America, and Asia).4,5 The increase in clinical effectiveness from these new therapies ...