Changes in Cost of Guideline-Concordant Cancer Treatment: Observations and Implications.

Purpose: Cost of cancer care in the United States is substantial. Previous studies have explored pricing comparisons at the level of individual cancer drugs but not that of clinical indications. This study evaluates cost patterns for providing the best guideline-concordant therapy for solid tumor treatment indications.

Methods: We identified all National Comprehensive Cancer Network guideline-concordant treatment indications for the 17 most common solid tumor malignancies in 2017 and 2021. Best-available treatments were determined for each indication using National Comprehensive Cancer Network Evidence Block scores. We grouped treatments by (1) those administered on an ongoing basis (priced per month) and (2) those administered for a prespecified duration (priced per course of therapy). Costs were calculated using Medicare reimbursement rates and analyzed across both time points.

Results: Across all indications, median cost of the best-available cancer treatment changed from $10,784 in US dollars (USD) (IQR, $691-$16,489 [USD]) in 2017 to $17,936 (USD) (IQR, $2,640-$19,209 [USD]) in 2021 for regimens administered on an ongoing basis, and from $10,501 (USD) (IQR, $6,068-$51,365 [USD]) in 2017 to $9,038 (USD) (IQR, $5,045-$79,386 [USD]) in 2021 for regimens administered for a set duration. Among the subset of indications newly present in 2021, median costs were higher at $21,524 (USD) (IQR, $5,639-$22,369 [USD]) per month for ongoing regimens and $17,005 (USD) (IQR, $6,178-$258,284 [USD]) per course for prespecified regimens. Among the subset of indications present in both 2017 and 2021, relative change in cost of the best-available treatment was -2% (IQR, -39% to +9%). Indications for which the best-available treatment had a new generic or biosimilar entrant (N = 16), median cost decrease was substantially larger at -57% (IQR, -78% to -44%).

Conclusion: This study observed an increase in absolute median cost of cancer therapy on a treatment indications level, largely driven by new biomarker-driven indications and therapies.