Does Off-Label Chemo Drive Up Healthcare Costs?

David Kerr, CBE, MD, DSc, FRCP, FMedSci


September 13, 2013

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Hello. I am David Kerr, Professor of Cancer Medicine at University of Oxford in the United Kingdom, and past President of ESMO (European Society for Medical Oncology). Today I want to discuss an interesting study[1] that has attempted to quantify the use of off-label chemotherapy in the United States. This study was reported in the Journal of Clinical Oncology by Dr. Conti and colleagues from the University of Chicago. It was a very worthy attempt to use national databases to try to understand what has been presented by some as a problem at a time when US healthcare costs are approaching 20% of the GDP. Many commentators have suggested that one of the significant contributors to this is expensive anticancer treatments, which are considered to be of moderate value but are associated with a large burden of cost.

These investigators used a national prescribing database to collect information on 10 patented chemotherapy drugs. All of these drugs were given by intravenous injection or infusion. The database was generated from a range of 122 oncology practices, employing 570 oncologists in 35 states in the United States. The audit was undertaken in 2010 and involved 19,500 patients. The authors then used the costs of drugs in the sample set. They analyzed the total drug sales and used that to extrapolate a national figure. Of course there are caveats to such a study, but nevertheless this was an honorable attempt to generate cohesive and collective data.


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