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Health care policy discussions in the US are often framed in absolutist terms. In particular, there is a widespread belief among the public that treatment –especially for serious illnesses– should be undertaken without regard to cost. Many are wary about comparative effectiveness research –the main concern is that the government will use the results to ration care. With this backdrop, I was interested to read a new paper in Health Affairs: Cancer Therapy Costs Influence Treatment: A National Survey of Oncologists by Peter Neumann et al.

Peter is the director of the Center for the Evaluation of Value and Risk in Health (CVER) at Tufts Medical School. I’m a member of the CEVR Executive Advisory Board so have been following the comparative effectiveness debate more closely of late.

Here’s the abstract:

A national survey of medical oncologists indicates that rising cancer treatment costs are influencing clinical practice, even as oncologists tend not to communicate with patients about costs. The survey shows that 84 percent of oncologists say that patients’ out-of-pocket spending influences treatment recommendations. Only 43 percent always or frequently discuss costs with patients. Among those surveyed, 79 percent favor more comparative effectiveness research; 80 percent support more cost-effectiveness data, although only 42 percent feel well prepared to interpret it. The results suggest that physicians support federally funded comparative effectiveness research but that they wish to retain a central role in making decisions about how and when to use expensive cancer treatments. The results also support educating physicians about cost-effectiveness and how to communicate with patients regarding cost.

Like it or not, your oncologist is probably already taking cost into account in prescribing treatment. To expand a bit on the 79 and 80 percent numbers in the abstract,  80 percent refers to the percent of oncologists who think more cost-effectiveness data should be used in coverage and payment decisions. Seventy-nine percent want more government research on comparative effectiveness of cancer drugs.

While oncologists want government sponsored research and want the results to be used for payment, they don’t tend to want the government or insurance companies to “determine whether a drug provides good value.” Not surprisingly, 60 percent of respondents think physicians should make the determination. But it is interesting to me that the next two choices were a nonprofit (57 percent) and patients (37 percent). For comparison 21 percent said government and 6 percent insurance companies.

Overall I’m encouraged that oncologists are so enlightened about comparative effectiveness. They have observed through their own clinical and research experience that costs have to be a consideration even in life and death matters. They want more, objective research on the subject. And they do not seek to monopolize the interpretation and implementation of the results.

Those who oppose comparative effectiveness research on the grounds that it will lead to the rationing of care should be aware that oncologists are already taking cost into account and expect to do so to a greater extent in the future. We might as well have them base their decisions on solid research.

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