David Wazer, Director at Brown Health Cancer Institute, shared on LinkedIn:
“Oncology’s distorted marketplace: Rewarding cost over cure
Chirag Shah’s provocative JAMA Oncology Viewpoint, ‘Rethinking Value in Cancer Care in the US,’ offers a compelling and long-overdue challenge to the economic priorities governing American cancer care.
His central argument is both simple and difficult to dispute:
‘The price of cancer treatment has become increasingly disconnected from its clinical value.’
Shah’s juxtaposition of stereotactic ablative radiotherapy in SABR-COMET with pembrolizumab in KEYNOTE-355 is particularly illuminating.
Although these trials involve fundamentally different populations and cannot be directly compared for efficacy, their dramatically divergent treatment costs expose a troubling imbalance in how we financially reward therapeutic innovation.
Over the past decade, systemic anticancer drug launch prices have increased approximately 155%, while radiation therapy reimbursement has declined 25%. This disparity is neither clinically defensible nor economically sustainable.
Importantly, this should not become a contest between radiation oncology and medical oncology. Modern cancer care depends upon their complementary contributions. Rather, Shah correctly challenges an increasingly entrenched assumption that meaningful innovation principally comes from pharmaceutical development.
Innovation also means:
- delivering curative treatment more efficiently,
- reducing toxicity,
- preserving organ function,
- improving local control,
- and enhancing quality of life.
These benefits deserve recognition in both value assessments and reimbursement policy.
I particularly endorse Shahs call for rational pharmaceutical pricing, appropriate reimbursement for radiation therapy, and payment models that reward demonstrable patient benefit rather than treatment expense.
The real question is not whether we can afford innovative cancer care. It is whether we can afford a system that consistently confuses price with value.
Shah has articulated an argument that policymakers, payers, oncologists, and patients would do well to embrace.”
Title: Rethinking Value in Cancer Care in the US
Authors: Chirag Shah.
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