Big Jump in US Spending on Cancer Drugs From 2011 to 2016

Nick Mulcahy

September 20, 2018

Total expenditures for cancer drugs, including new immunotherapies and targeted agents, in the United States jumped from $26.8 billion in 2011 to $42.1 billion in 2016.

During the same period, the US Food and Drug Administration approved 52 new cancer therapies.

The findings come from a unique study published online September 18 in the Journal of Oncology Practice.

Spending on antineoplastic drugs increased 0.4% in 2012, 6.3% in 2013, 13.4% in 2014, 15.6% in 2015, and 12.2% in 2016, report the authors, led by Samuel Hong, of Astellas Pharma and formerly of the University of Illinois at Chicago.

Additionally, from 2011 to 2016, oncology was ranked the highest therapeutic area in specialty drug spending, they note.

"The reasons for growth in cancer drug expenditures include technology advancements, increasing prices, changing patient demographics, and changes in duration of therapy," summarize the authors.

Notably, the new data reflect wholesaler purchases rather than what is actually paid by patients or insurance companies, which would be higher.

Surprisingly, the study is the only one of its kind to use recent perspective national sales data on the entire range of cancer drugs in the United States.

Other recent studies on the cost of cancer drugs have relied on cost projections or have focused on subgroups of drugs or subpopulations of cancer patients, say the authors.

Which Drugs Are Rising, Dropping

For their study, Hong and colleagues used the IQVIA (previously QuintilesIMS and IMS Health) National Sales Perspectives database.

The database derives from annual transactions from pharmaceutical manufacturers to wholesaler distribution centers and, in turn, their sales to nonfederal hospitals, clinics, retail pharmacies, mail-service pharmacies, home health facilities, long-term care outlets, and other entities.

From 2011 to 2016, clinics accounted for the largest portion of total cancer drug expenditures (roughly half), followed by mail-order pharmacies (roughly one quarter), nonfederal hospitals (less than 20%), and retail pharmacies (a little less than 10%).

The authors utilized data for hospitals and clinics to identify trends in individual drug types from 2011 to 2016.

The three agents that saw the largest overall decrease in expenditures were traditional cytotoxic drugs that became generic during that time: oxaliplatin (Eloxatin, Sanofi Aventis), -97%; docetaxel (multiple brands), -89%; and gemcitabine (multiple brands), -92%.

The three agents with the largest average annual expenditures were older biologics: rituximab (Rituxan, Genentech), $3.5 billion; bevacizumab (multiple brands), $2.9 billion; and trastuzumab (multiple brands), $2.2 billion.

The three antineoplastic drugs with the largest growth in expenditures were the newer biologics checkpoint inhibitor immunotherapies: nivolumab (Opdivo, Bristol-Myers Squibb), $0.8 billion in 2015 to $2.6 billion in 2016, a 238% increase; pertuzumab (Perjecta, Genentech), $0.2 billion in 2013 to $0.9 billion in 2016, an 80% increase; and pembrolizumab (Keytruda, Merck Sharp Dohme), $0.4 billion in 2015 to $0.7 billion in 2016, an 84% increase.

The various expenditures cited in the study would be higher, but there are no data from the Veterans Affairs system since 2014, the authors add.

In the discussion section of the article, the team worries about the spiraling expenditures and reviews possible controls. They do not advocate for value-based policies and observe that "stakeholders are being cautious in strictly promoting value-based policies."

The authors also review some unprecedented or highly unusual maneuvers in US healthcare to control cancer drug costs.

They point that for the first time, CVS Health has excluded brand-name cancer drugs, including imatinib (Gleevec, Novartis) and enzalutamide (Xanti, Pfizer/Astellas) from its formulary. "This strategy is controversial, because they may restrict access to life-saving or extending treatments," the authors add.

Another proposed strategy, say the authors, is "to allow the largest payer for oncology drugs, the Centers for Medicare and Medicaid Services [CMS], to negotiate drug prices — a practice that is currently not allowed by law."

CMS is currently developing the Oncology Care Model, which seeks to provide higher-quality care at a lower cost through the use of clinical pathways, note the authors.

"Regardless of the future approaches taken, the information presented in our study serves as a baseline measure of actual transaction costs associated with antineoplastics by the health care sector in the United States," the authors conclude.

Multiple study authors have disclosed financial ties to pharmaceutical companies.

J Oncol Pract. Published online September 19, 2018. Abstract

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.