Can Money Really Be No Object When Cancer Care Is the Subject?
Menée à l'aide de deux modèles mathématiques, cette étude américaine évalue le rapport coût-efficacité de l'ajout du bévacizumab à une chimiothérapie de première ou seconde ligne pour traiter un cancer métastatique du côlon-rectum
Drug prices are the most rapidly increasing component of American health care costs, and cancer drugs in particular have been leading this meteoric rise.1 For medical care in general and cancer treatment in particular however, we have, at least in the United States, embraced the notion that such care should be, unlike virtually all other goods and services, above discussion of, and indeed even consideration of, cost. In fact, the US Food and Drug Administration does not consider cost in the evaluation and approval process of new drugs, while Medicare acts without ability to directly negotiate prices of drugs or consider cost-effectiveness information,2 thereby essentially compelling Medicare to purchase the drugs the US Food and Drug Administration approves at any price that a pharmaceutical company chooses to set. In parallel, we have created a health care system heavily dependent on third party payment, in which few individuals are paying with their own money, and even fewer could afford to do so. The result of this well-intentioned but ultimately unrealistic structure is our current health care morass, in which costs are spiraling out of control, a disconnect has been created between cost and value, and the descriptive word unsustainable is used with such frequency that we have become numb to its meaning; we decline to consider what follows when our unsustainable system, once no longer sustained, fails, and what havoc will be wreaked in terms of even further widening of health care disparities and lack of access to necessary care when that happens.