AHIP's Fuzzy Math on Value

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  • 06/17/2014

Recently Allison Bell,  a blogger for LifeHealthPro.com,  a newsletter focusing on how insurance companies can maximize revenue posted on CMPI's effort to focus on the value of new cancer treatments from the patient's perspective..  Here's her post and my reply. 

On the Third Hand: Drugs Opinion

Thanks Allison,

You raise important questions that need to be answered.. unfortunately until now no one has wanted to check the math.

Here's some math: According to IMS the number of targeted has increased from 11 percent of all cancer drugs to 46 percent of all drugs over the past decade. The average price of drugs has doubled. Meanwhile, cancer drugs as a percent of healthcare spending has actually declined. The rate of hospitalization for cancer has fallen by 20 percent during the same time period. Cancer mortality rates have declined 20 percent. Productivity gains of people living cancer free are conservatively estimated at $68 billion a year, or 2.5 times more than what was spent on new treatments.

New drugs and diagnostics are responsible for 90 percent of these gains.

I would argue that the way to make a system sustainable is to increase productivity (which leads to more people paying premiums and taxe) and reduce the use of more labor intensive services like hospitals. Without new cancer drugs there would be 6 milion fewer people alive today. Without 'expensive' HIV drugs that are also being rationed by health plans, there would be 3-5 milion fewer people alive today. If you cut the work force and tax base by 20- 30 percent by denying access in ways AHIP wants, what happens to the financial support everyone seems to worry about.

The greatest gains will come when more cancer care is personalized and is matched the right time, the first time to patient tumor variability. Yet the ASCO and AHIP plan guidelines discourage and delay the adoption of such innovations.

The fact is, no one with ASCO or AHIP has discussed this math. I offered several times to be part of such discussions. No response. Lowell Schnipper who runs the ASCO value task force has written it’s not worth treating patients if it ‘only’ adds three months of life because “it is not a large enough benefit to trump the greater benefits to many that would have to be foregone to provide it.” Indeed, he believes the problem (of wanting to live longer) “ may be a particularly American one; other cultures do not seem to view the postponement of death by a few months” as important as Americans.

Has anyone covered the fact that the Wellpoint bonus program for cancer doctors measures value in the same way ASCO will measure it: efficacy, toxicity and cost. No mention of quality of life from the patient's perspective. Or how about that both Lee Newcomer and Schnipper said that the way to herd people into pathways that save money for health plans is to have the doctors develop the guidelines so that the plans are not accused of being self-serving (Schnipper and Newcomer's words, not mine). Shouldn't this be a subject of journalistic, if not congressional investigation? Shouldn't such cooperation -- with patients left on the sidelines -- be a source of concern?

Also, ask yourself: Should we take AHIP and critics of drug prices at their word because they don't get funding from pharma and ignore what I and others say because we get support from pharma? Does that mean that groups getting money from AHIP or health plans are to be believed? Is truth a function of where you get funding? Paul Offit did work for Merck on the rotavirus vaccine.. Does that mean that what he said about vaccines NOT causing autism should be discounted whereas Jenny McCarthy should be accepted.

When people attack where CMPI gets it support rather than engaging on the substance, it's a sign of desperation. I expect more of the same as the untenable and discriminatory assault on chronically ill patients continues.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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