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Do Oncologists Believe New Cancer Drugs Offer Good Value?(一)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:34

  作者:Eric Nadlera, Ben Eckertb, Peter J. Neumannb

  【关键词】 Health,policy,•,Cost-benefit,analysis,•,Chemotherapy,•,Health,care,economic

  LEARNING OBJECTIVES

  After completing this course, the reader will be able to:

  Describe how academic oncologists view the costs of new treatments in their treatment recommendations.

  Discuss academic oncologists’ perceptions of the cost and benefit of one new treatment in light of published results.

  Describe how academic oncologists view the cost-effectiveness of new treatments relative to previously accepted standards.

  ABSTRACT

  

  Background. 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.

  Methods. 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.

  Results. 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."

  Conclusions. 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.

  INTRODUCTION

  

  Over the past 5 years, a number of innovative cancer treatments have entered clinical practice. The prices of many of these agents exceed $25,000 a year and result in benefits measured in months. The dramatic tradeoff between cost and clinical benefit has made their adoption a touchstone for broader debates over appropriate resource allocation in health care. The discussion over the high costs and relative value of new cancer medications has leaped from

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