The rising cost of cancer care is an undeniable challenge to a more economically sustainable healthcare future. To tackle the challenge effectively, we need to define and measure it in ways that truly matter to stakeholders, and most of all to patients.

There is no single way to look at the economics of cancer care, and every approach has its merits and limitations. There is total cost of care – the sum of all expenditures that go into caring for a patient over time, with medicines being one component. Or we can look at cost-effectiveness, a measure of trade-offs between different treatments, in terms of added benefits and resulting expenditures.

And then there’s value. In healthcare, value is a way of considering the benefits of a given treatment to patients, to other stakeholders, and to society, and the degree to which those benefits justify costs. Value can account for total cost of care and cost-effectiveness, but it also tells a more complete story. To understand why, it helps to look at what the other measures tell us and what they don’t.

TOTAL COST MATTERS, BUT VALUE MEANS MORE IN ONCOLOGY

Total cost of care, though easy to conceive, is not so simple to tally. For starters, it encompasses so many different components of care – doctor visits, hospitalizations, surgeries, labs, imaging, and various supportive services, and of course the purchase and administration of cancer medicines. Total cost can depend on where patients receive their care, what complications they experience, and the degree to which expenditures in one component – say, on innovative medicines – can help decrease costs in other areas – for example, by reducing the need for hospitalizations, emergency visits, or surgery.

Encouragingly, progress in cancer prevention, screening, and treatment can help to reduce the total cost of care or keep it in check. One analysis of the years 1995-2015 found that, on a per-person basis, spending on medical care for lung cancer and breast cancer was cost-effective and associated with substantial reductions in the burden of both diseases. Accounting for inflation and for changes in the number of people affected by each disease, total costs per person decreased for lung cancer and increased only slightly for breast cancer in that 20 year period.¹

At Genentech, we aim to reduce total cost of care whenever possible. We have, for example, developed multiple “fixed-duration treatment regimens” for different hematologic cancers. A fixed-duration regimen is an approach that requires patients to receive treatment for a finite period (e.g., one year), which runs counter to the “treat to progression” strategy widely used in cancer care, where patients remain on a treatment until their cancer grows or spreads. According to a recent study, fixed-duration regimens can reduce the total cost of care for patients and the larger healthcare system while providing better efficacy and comparable safety profiles compared to older treatments.^2,3

In that case, it is easy to grasp the significance of the savings. But more broadly, total cost of care has a key limitation: it tells us only that cost increases or decreases happened, not what drove them or whether patient outcomes were improved.

Research that considers the aggregate benefits of cancer treatments can be helpful. With breast cancer, for example, medicines that target the HER2 gene have substantially improved the outlook for about 15 to 20 percent of patients whose tumors have the gene. HER2-positive disease used to be one of the most aggressive, and thus deadly, forms of breast cancer. Now, people with HER2-positive breast cancer have a better prognosis than those with HER2-negative disease.⁴

Encouraging findings, to be sure. But it’s still only a partial picture of what cancer treatments mean for patients, let alone for their physicians or insurers. That leads to us value.

Value is at once more meaningful and more complex than total cost of care or cost-effectiveness. It inherently raises the question: “Value to whom?”

And while value is not a new concept in medicine, there is not yet a widely agreed-upon method of assessing it. To paraphrase a 2018 report from the U.S. President’s Cancer Panel, an ideal framework for value would integrate information on a treatment’s clinical outcomes, its impact on quality of life, and its costs, accounting for the needs of all stakeholders.

We believe precise, widely accepted measures of value in cancer are urgently needed. We’re actively involved in conversations – with payers, policymakers, and of course patient organizations – about how value should be defined and measured.

PURSUING VALUE ON MULTIPLE FRONTS

At the same time, the concept of value is clear enough today that we’re compelled to pursue it in several areas of our work in oncology:

• We seek to deliver value by improving patient outcomes. For a patient facing a cancer diagnosis, little can eclipse the value of more time – to spend with family, to travel, to pursue their passions. Longer life, slowing disease progression, or avoiding relapses may also mean more economic productivity, benefiting families and communities alike.
• We work to help patients maintain or improve health-related quality of life. This means developing and delivering treatments in ways that account for patient preference, convenience, side effects, and more.

  For example, as our colleagues have discussed, we place high importance on creating formulations that are preferred by patients while saving capacity and costs for healthcare systems. Along with fixed-duration treatments, this includes creating treatments that can be delivered as a gradual injection under the skin, helping patients avoid the hassle and cost of sitting for long stretches in an infusion chair.

• We work to maximize economic gains to society. In some cases, that is simply a byproduct of success in extending patients’ lives or time without disease progression, along with their ability to stay productive. But there’s plenty more we can do: pricing our medicines responsibly, in order maximize access for patients while preserving our ability to invest in future advances; engaging with policymakers to drive adoption of innovative pricing and reimbursement strategies; and collaborating with public health and advocacy organizations to promote cancer screening and earlier diagnosis, which can mean better outcomes and reduced costs for society.

We believe our medicines bring clinical, economic and human value to patients, their caregivers, and their families, and we’re proud of the contribution Genentech has made to cancer survival.^5,6 At the same time, we know that the work of defining cancer care value is a work in progress. We’re committed participants in that discussion, and will continue to look holistically at the value of our medicines across the entire healthcare ecosystem.