1 Global Partners, Powell, Ohio.
J Manag Care Spec Pharm. 2019 Feb;25(2):272-281. doi: 10.18553/jmcp.2019.25.2.272.
The cost of treating cancer patients is high and rising in the United States. Payers are exposed to cost through doctor visits, laboratory tests, imaging tests, radiation treatment, drugs, hospital stays, surgery, home care, transportation and travel, and caregiving. This study focuses on the cost of medication from the viewpoint of U.S. payers. Although new tools for managing these costs have been gaining attention, prices continue to rise, and challenges to managing costs remain high. Innovative tools are necessary for controlling the cost of care in oncology, but their effectiveness is still unclear.
To (a) gauge payer perceptions of current and future cost management of innovative oncology drugs and (b) predict which management tools will increase in prevalence by 2020-2022.
A literature search of cost and management of oncology created the foundation for developing a survey for U.S. payers. The mobile survey was completed on devices such as smart phones or tablets. Payers were asked about general oncology product management, use of specific management tools today, management challenges, and expected use of specific management tools in 2020-2022. Management tools were segmented into traditional (used across many therapeutic categories), oncology-specific (used in oncology but not routinely used in other disease areas), and systemic (not product-specific but that affect the way services are provided and funded). Specific questions for managing the cost of care in non-small cell lung cancer (NSCLC) and chronic lymphocytic leukemia (CLL) were included in the survey. NSCLC and CLL were chosen because of their diverse clinical characteristics and the level of innovation in these disease areas. The survey was fielded from May 31, 2017, to June 15, 2017. Results consisted of simple descriptive statistical analysis weighted by the payer's reported organizational covered lives.
Payers were concerned with the high cost and budget impact of oncology drugs and considered these a high priority for management. However, they continue to use traditional management tools such as manage to FDA label, quantity limits, step edits, and reauthorizations, which are ineffective in controlling cost. More innovative management tools such as pathways of care are available but are not yet widely adopted. Payers hope to better control oncology cost in the future; however, specific questions pertaining to the management of NSCLC and CLL indicate that minimal changes in cost management will occur by 2020-2022.
Despite an increasing number of innovative cost management tools, challenges remain for managing oncology medication costs. New incentives are being generated, but barriers to their implementation will continue to restrict use through 2020-2022.
No outside funding supported this study. The authors are employed by MKO Global Partners, which is a consulting firm that focuses on payer strategy and market access in the pharmaceutical and biotech markets. Some initial results from this research were published as part of a comparative poster at ISPOR European Conference; November 4-8, 2017; Glasgow, Scotland, UK.
在美国，治疗癌症患者的成本高昂且不断上升。支付方通过医生就诊、实验室检查、影像检查、放射治疗、药物、住院、手术、家庭护理、交通和旅行以及护理来承担这些费用。本研究从美国支付方的角度关注药物治疗的成本。尽管管理这些成本的新工具已受到关注，但价格持续上涨，管理成本的挑战仍然很大。创新工具对于控制肿瘤学的护理成本是必要的，但它们的效果仍不清楚。
（a）评估支付方对创新肿瘤药物当前和未来成本管理的看法，（b）预测哪些管理工具将在 2020-2022 年增加使用。
对肿瘤学的成本和管理进行文献检索，为美国支付方开发了一项调查。移动调查是在智能手机或平板电脑等设备上完成的。支付方被问及一般肿瘤产品管理、当前使用特定管理工具、管理挑战以及预计在 2020-2022 年使用特定管理工具。管理工具分为传统工具（用于许多治疗类别）、肿瘤学专用工具（用于肿瘤学，但不常规用于其他疾病领域）和系统工具（非产品专用，但影响服务提供和资金方式）。调查中还包括了非小细胞肺癌（NSCLC）和慢性淋巴细胞白血病（CLL）护理成本管理的具体问题。选择 NSCLC 和 CLL 是因为它们具有不同的临床特征和这些疾病领域的创新水平。该调查于 2017 年 5 月 31 日至 6 月 15 日进行。结果由简单的描述性统计分析组成，加权由支付方报告的组织覆盖生命数。
支付方对肿瘤药物的高成本和预算影响感到担忧，并将其视为管理的重中之重。然而，他们继续使用传统的管理工具，如根据 FDA 标签、数量限制、步骤编辑和重新授权进行管理，这些工具在控制成本方面效果不佳。更具创新性的管理工具，如护理路径，已经可用，但尚未广泛采用。支付方希望在未来更好地控制肿瘤学成本；然而，与 NSCLC 和 CLL 管理相关的具体问题表明，到 2020-2022 年，成本管理的变化将很小。
尽管有越来越多的创新成本管理工具，但管理肿瘤药物成本仍面临挑战。新的激励措施正在产生，但到 2020-2022 年，实施这些激励措施的障碍将继续限制其使用。
本研究无外部资金支持。作者受 MKO Global Partners 雇用，该公司是一家专注于制药和生物技术市场支付方战略和市场准入的咨询公司。该研究的一些初步结果作为比较海报的一部分发表在 ISPOR 欧洲会议上；2017 年 11 月 4 日至 8 日；英国格拉斯哥。
