The Market for Suboptimal Cancer Care

If you know anyone with cancer, today’s story in the NYT (“Market Forces Cited in Lymphoma Drug’s Disuse“) is a must-read. It shows why patients need to understand not only some medical science when evaluating a doctor’s advice, but also the field of insurance law and health financing that shapes treatment patterns.

The story focuses on development of “new class of drugs [Bexxar and Zevalin] called radioimmunotherapies” for non-Hodgkins’ lymphoma–the “fifth most common cancer in the United States, with 60,000 new cases and almost 20,000 deaths a year.” Both Medicare and private insurers provide financial incentives for doctors not to use the drugs–which may not be surprising given the survivors’ costs issues I blogged earlier. In part because of these incentives, “many doctors prescribe Bexxar and Zevalin only as a last resort, when they are unlikely to succeed because the cancer has advanced.”

What’s really astonishing is how, even if one gets rid of the survivors’ costs issue, incentives in the current insurance market can lead to courses of treatment that are costlier than higher-quality alternatives. Bexxar costs $25K, and need only be given once in most cases, while the cost of the currently prevalent Rituxan is $20K. Rituxan may end up being given many more times, and so its cost may quickly supplant that of Bexxar.

One would think that a private insurer would opt for the Bexxar, given that the cost of Rituxan might quickly outstrip that of Bexxar. However, Americans frequently switch insurance plans, and that churn can make it economically rational for an insurer to focus on short-term instead of long term costs. As the article concludes, “market-driven forces . . . [can result] in high costs but not necessarily the best care.” Any medical advice probably has to be interpreted in light of our system of money-driven medicine.

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