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Boom in Oncology Research Raises Concerns About Costs

By Peter Winter
BioWorld Insight Editor

According to the American Cancer Society an estimated 1.6 million new cancer cases and 577,190 deaths from cancer are projected to occur in the U.S. in 2012. It is not surprising then that recent studies have found that there are more ongoing clinical trials focusing on cancer indications than any other disease. However, costs are rising in cancer treatment, putting tremendous strains on the health care system.

In a paper by Thomas Smith and Bruce Hillner, published in The New England Journal of Medicine in May 2011, the authors wrote that annual direct costs for cancer care are projected to rise to more than $173 billion by 2020 driven by the cost of therapy and the extent of care. In the U.S., the sales of anticancer drugs are now second only to those of drugs for heart disease and 70 percent of these sales come from oncology therapies introduced in the past decade, Smith and Hilner note.

A July 2012 study completed by the Tufts Center for the Study of Drug Development (TCSDD) found that cancer patients in the U.S. get faster access to more oncology drugs to treat their disease than patients in Europe. In addition, the study found, new oncology drug approvals in the U.S. outpaced European approvals by 33 percent between 2000 and 2011. The study also found that oncology drug prices in Europe, on average, are 9 percent lower than in the U.S.

Helping find an effective solution to these troubling statistics will be the task of a newly created research institute at the Fred Hutchinson Cancer Research Center. Scheduled to begin operations early next year, the Institute for Cancer Outcomes Research and Evaluation (ICORE), will focus its operations on health economics and cancer outcomes research. It plans to examine potential new models designed to improve the efficiency and effectiveness of cancer prevention, early detection and treatment and maintain the quality of cancer care while reducing the financial burden of cancer for patients, health systems and society.

"Cancer care in the United States is in crisis," said Scott Ramsey, a leading authority in health care economics, and the first director of ICORE, in a statement. "The current environment in oncology health care delivery and policy make this an ideal time to focus on health economics, comparative and cost-effectiveness research, and health care policy," he added.

The Hutchinson Center is providing initial funding for the institute, which is expected to be self-sustaining over time, supported by a combination of federal and nonfederal research grants, industry contracts and donations, and private and foundation gifts.

The institute is forming during a period of intense research and development productivity in the biopharmaceutical sector. According to a recent report from Citeline on the level of pharma R&D in 2012, 29.5 percent of all drugs currently in research and development have an oncology focus. These findings are in line with data in a separate report released by the Pharmaceutical Research and Manufacturers of America (PhRMA) in May 2012, which found that America's biopharma research companies collectively have in their pipelines 981 medicines and vaccines targeting cancers. These potential therapies, are either in clinical trials or under review by the FDA.

"While greater access to more treatment options is definitely a positive for patients in the U.S., it is not clear if greater access leads to better health outcomes," noted Joshua P. Cohen, research assistant professor at Tufts CSDD who conducted the TCSDD analysis.

He said that the growing use of comparative effectiveness research, which provides information on the relative strengths and weaknesses of different medical technologies, could help close the gap between what is known and what is done in pharmaceutical care.

"Although more oncology drugs are available in the U.S., and the costs for a higher share of them are reimbursed, the evidence-based approach adopted by European systems have improved the affordability of drugs in Europe that are considered to be cost-effective," Cohen said.

Citeline's analysis finds that more than half of their "top 25 diseases" are oncology indications with breast cancer in the number one spot as the single most targeted disease. Prostate cancer and colorectal cancer occupied the third and fourth positions in the list, with lung, pancreatic and ovarian cancers also placing in the top 10 positions.