The San Antonio Breast Cancer Symposium is a study in contrasts every year. Expensive suits mingle with headscarves. Glossy industry promotions include details about horrible side effects of treatments. And rows of tricked-out booths are occasionally interrupted by modest nonprofit booths, like our own.
The reality – which is on prominent display at SABCS – is that there’s a lot of money in breast cancer research and treatment. In the presence of such excess, I can’t help but think about the unbearable financial burden on breast cancer patients, who are strained and stressed and, too often, bankrupted by the financial toll of the disease.
And every year at SABCS, whenever I can, I make the point that all the research to study new populations who might benefit from expensive treatments, and to develop promising new treatments, can’t possibly save any lives if the people who need treatment can’t get it. And I question choosing expensive options that offer no advantages for patients. [See my earlier blog post from SABCS: “T-DM1 tradeoffs: not worth the costs and side effects in early stage breast cancer.”]
Because I know that breast cancer is big business, last Friday morning I got up early—very early California time!—to attend a Spotlight Session on Toxicity, Tolerability & Cost. These topics are absolutely central to breast cancer treatment, yet they were relegated to a 7 a.m. time slot on the third day of the conference.
Breast cancer accounts for the largest share – 14.4 percent — of cancer spending. A whopping $19.7 billion was spent on breast cancer care in 2018. The discussion sped through a long list of jaw-dropping and devastating data about the high costs of breast cancer treatment in the US that, unfortunately, comes as no surprise.
What are we really getting for all that money?
Outcomes Over Spending
Comparing the US to other countries, breast cancer outcomes are relatively similar, but costs are more than twice as high. Those costs are borne by society, but also by individuals (with high out of pocket expenses, etc.).
Even though the presenters didn’t directly address the question of why patients in the US aren’t faring better when we’re spending so much more, a partial reason was implied by one of the abstracts included in the session. Researchers looked at the costs and outcomes of 18 breast cancer drugs approved in the US between 2006 and 2019, and reviewed 28 pivotal trials used to support the approval of these drugs for 24 indications.
During that period, only 7% of breast cancer drugs approved by the FDA showed overall survival benefit. Put simply, more than nine out of ten drugs approved to treat breast cancer since 2006 have not been proven to help people live longer. Let that sink in.
So, if people aren’t living longer, are the new FDA approved treatments less toxic, resulting in the same outcomes as existing treatments but with improved quality of life? Only 14% of approved breast cancer treatments since 2006 improved quality of life.
The average cost of new breast cancer treatments is more than $10,000 per month.
The value of medicines is measured according to a simple formula: outcomes over spending. As Dr Michael Hasset quipped: the math is easy but the calculation is hard. Outcomes and spending depend on your perspective. Which outcomes and costs are included?
When even patients with insurance can’t afford to take their medication, the issue isn’t just how the value of the medicine is calculated, but our values as a society.
And when the vast majority of breast cancer treatments approved since 2006—for which we’re paying at least $100,000 per year—have not been proven to help people live longer or feel better, that’s a rip-off at any price.