Nadler Eric, Eckert Ben, Neumann Peter J
Dana-Faber Cancer Institute/Harvard Medical School, Boston, MA, USA.
Oncologist. 2006 Feb;11(2):90-5. doi: 10.1634/theoncologist.11-2-90.
Substantial debate centers on the high cost and relative value of new cancer therapies. Oncologists play a pivotal role in treatment decisions, yet it is unclear whether they perceive high-cost new treatments to offer good value or how therapeutic costs factor into their treatment recommendations.
We surveyed 139 academic medical oncologists at two academic hospitals in Boston. We asked respondents to provide estimates for the cost and effectiveness of bevacizumab and whether they believed the treatment offered "good value." We also asked respondents to judge how large a gain in life expectancy would justify a hypothetical cancer drug that costs $70,000 a year. Using this information, we calculated implied cost-effectiveness thresholds. Finally, we explored respondents' views on the role of cost in treatment decisions.
Ninety academic oncologists (65%) completed the survey. Seventy-eight percent stated that patients should have access to "effective" care regardless of cost. Implied cost-effectiveness thresholds, derived from the bevacizumab and hypothetical scenarios, averaged roughly $300,000 per quality-adjusted-life-year (QALY). Only 25% of oncologists felt that bevacizumab offered "good value."
A majority of academic oncologists stated that cost does not influence their clinical practice, nor should it limit access to "effective" care. Yet respondents did not consider all effective drugs to be of good value. Implied cost-effectiveness thresholds were $300,000/QALY--a value higher than the $50,000 standard often cited. A subset of oncologists were sensitive to cost, believing it should factor into clinical decisions. These findings reflect the ongoing controversies within the medical community as expensive new therapies enter the system.
关于新型癌症治疗方法的高成本和相对价值存在大量争论。肿瘤学家在治疗决策中起着关键作用，但尚不清楚他们是否认为高成本的新治疗方法具有良好价值，以及治疗成本如何影响他们的治疗建议。
我们对波士顿两家学术医院的139名学术肿瘤内科医生进行了调查。我们要求受访者提供贝伐单抗的成本和有效性估计，以及他们是否认为该治疗具有“良好价值”。我们还要求受访者判断，一种每年花费7万美元的假设性癌症药物，预期寿命延长多少才合理。利用这些信息，我们计算了隐含的成本效益阈值。最后，我们探讨了受访者对成本在治疗决策中的作用的看法。
90名学术肿瘤内科医生（65%）完成了调查。78%的人表示，无论成本如何，患者都应获得“有效”治疗。从贝伐单抗和假设情景得出的隐含成本效益阈值平均约为每质量调整生命年（QALY）30万美元。只有25%的肿瘤内科医生认为贝伐单抗具有“良好价值”。
大多数学术肿瘤内科医生表示，成本不会影响他们的临床实践，也不应限制获得“有效”治疗的机会。然而，受访者并不认为所有有效的药物都具有良好价值。隐含的成本效益阈值为30万美元/QALY，这一数值高于经常引用的5万美元标准。一部分肿瘤内科医生对成本敏感，认为成本应纳入临床决策。这些发现反映了随着昂贵的新疗法进入医疗体系，医学界内部持续存在的争议。
