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Cancer therapy: reimbursement of new therapeutic technologies
1Aetna Life and Casualty Company, Employee Benefits Division, Middletown, Connecticut.
Abstract:
New drugs and technologies for cancer treatment are being developed at a rate that has created a reimbursement crisis. This article discusses third-party concerns about this problem and describes generic criteria that have proven to be useful in assessing any new technology. It is equally important to discontinue funding of ineffective and obsolete therapies as it is to devise a strategy for identifying and encouraging the development of new therapy that will be both clinically useful and cost-effective. Examples are provided to show that these are not necessarily mutually exclusive goals. Off-label application of standard therapy as well as the funding of new cancer therapy are considered. High-dose chemotherapy with autologous stem-cell support for treatment of a variety of neoplasms has become a major reimbursement challenge. Other technologies such as autolymphocyte therapy and use of colony-stimulating factors are considered in detail. Finally, a process for deciding how to fund new cancer therapy is described.
Insights
Developing new cancer treatments presents a reimbursement challenge. This study outlines criteria for assessing new cancer therapies, emphasizing cost-effectiveness and clinical utility to manage funding effectively.
Area of Science:
- Oncology
- Health Economics
- Healthcare Management
Background:
- Rapid advancement in cancer therapeutics has outpaced reimbursement mechanisms, creating a significant financial challenge.
- Third-party payers face difficulties in evaluating and covering novel cancer treatments, including high-dose chemotherapy and autologous stem-cell support.
- Existing reimbursement strategies struggle to accommodate the influx of new cancer drugs and technologies.
Purpose of the Study:
- To address the reimbursement crisis in cancer treatment by establishing generic criteria for technology assessment.
- To propose a strategic approach for identifying, funding, and developing clinically useful and cost-effective cancer therapies.
- To evaluate the financial implications of advanced cancer treatments and inform funding decisions.
Main Methods:
- Review of third-party concerns regarding cancer technology reimbursement.
- Description of generic criteria for assessing the clinical utility and cost-effectiveness of new cancer therapies.
- Analysis of specific examples, including high-dose chemotherapy, autologous stem-cell support, autolymphocyte therapy, and colony-stimulating factors.
Main Results:
- Generic criteria can effectively assess new cancer technologies for clinical usefulness and cost-effectiveness.
- Discontinuing ineffective therapies is as crucial as funding new ones.
- Specific advanced therapies like high-dose chemotherapy present substantial reimbursement challenges.
Conclusions:
- A systematic process for funding new cancer therapies is essential to navigate the reimbursement crisis.
- Balancing innovation with cost-effectiveness is achievable through strategic assessment and funding.
- Future cancer treatment funding requires a framework that prioritizes both clinical benefit and economic viability.