Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
Am Soc Clin Oncol Educ Book. 2021 Mar;41:1-12. doi: 10.1200/EDBK_100028.
Increasing cancer drug prices present global challenges to treatment access and cancer outcomes. Substantial variability exists in drug pricing across countries. In countries without universal health care, patients are responsible for treatment costs. Low- or middle-income countries are heavily impacted, with limited patient access to novel cancer treatments. Financial toxicity is seen across cancer types, countries, and health care systems. Those at highest risk include younger patients, new immigrants, visible minority groups, and those without private health coverage. Currently, cancer drug pricing does not correlate with value or clinical benefit. Value-based pricing of oncology drugs may incentivize development of higher-value medicines and eliminate excess spending on drugs that yield little benefit. Generics and biosimilars in oncology can also improve affordability and patient access, offering dramatic reductions in drug spending while maintaining patient benefit. Oncologists can promote value-based care by following evidence-based clinical guidelines that avoid low-value treatments. Researchers can also engage in value-based research that critically explores optimal cancer drug dosing, schedules, and treatment duration and defines patient populations most likely to benefit (e.g., through biomarker selection). Cancer Groundshot proposes that we improve outcomes for today's patients with cancer, including broader global access for high-value treatments, promotion of affordable cancer control strategies, and reduction of cancer morbidity and mortality through low-cost prevention and screening initiatives. Moving forward, major oncology societies recommend promoting uniform global access to essential cancer medicines and avoiding financial harm for patients as key principles in addressing the affordability of cancer drugs.
癌症药物价格上涨给治疗的可及性和癌症结果带来了全球性挑战。各国之间的药物定价存在很大差异。在没有全民医疗保健的国家，患者需要承担治疗费用。低或中等收入国家受到严重影响，新型癌症治疗方法的患者可及性有限。癌症类型、国家和医疗保健系统都存在财务毒性。风险最高的人群包括年轻患者、新移民、少数族裔群体和没有私人医疗保险的人群。目前，癌症药物的定价与价值或临床获益无关。肿瘤药物的基于价值的定价可能会激励开发更有价值的药物，并消除对获益甚少的药物的过度支出。肿瘤学中的仿制药和生物类似药也可以提高可负担性和患者可及性，在保持患者获益的同时大幅降低药物支出。肿瘤学家可以通过遵循避免低价值治疗的基于证据的临床指南来促进基于价值的护理。研究人员还可以进行基于价值的研究，批判性地探索最佳的癌症药物剂量、方案和治疗持续时间，并确定最有可能受益的患者人群（例如，通过生物标志物选择）。癌症扫射倡议提出，我们要改善今天癌症患者的治疗效果，包括扩大高价值治疗方法的全球可及性、推广负担得起的癌症控制策略，并通过低成本的预防和筛查措施减少癌症发病率和死亡率。今后，主要的肿瘤学会建议促进全球普及基本癌症药物，并避免患者的财务损害，作为解决癌症药物可负担性问题的关键原则。
