Cost per Event Averted in Cancer Trials in the Adjuvant Setting From 2018 to 2022
- Importance: Evaluating the cost-effectiveness of adjuvant therapies based on the cost per event averted.
- Objective: To assess the costs per event averted for anticancer drugs approved by the FDA between January 2018 and March 2022.
- Design, Setting, and Participants:
- Cross-sectional study of FDA approvals.
- Included randomized trials of anticancer drugs for adjuvant treatment of solid tumors.
- Exclusions: Treatments of nonsolid tumors, nonrandomized/noncontrolled trials, and unpublished trials.
- Outcomes and Measures:
- Cost per event averted.
- Monthly cost and cost per patient for each drug.
- Primary clinical end points and trial design.
- Results:
- 11 approvals were analyzed.
- No overall survival benefit demonstrated; approvals based on surrogate end points.
- Median cost per event averted: $1,610,000 (range: $820,000 to $2,640,000).
- Median cost of complete adjuvant treatment: $158,000 per patient.
- Conclusions and Relevance:
- High costs per event averted for adjuvant anticancer agents.
- Limited widespread or global use without improvements in efficacy or reductions in price.
Globally, the price of cancer drugs is on an upward trajectory, with forecasts of global oncology therapeutic sales reaching $250 billion by 2024. In the US, the Centers for Medicare and Medicaid Services estimates that spending on healthcare will increase from USD 3.6 trillion in 2018 to approximately 6 trillion in 2027, approaching 20% of the gross domestic product, with the costs of cancer drugs playing a substantial role.
The financial burden of these increasing costs falls upon patients and societies. Recent analyses have examined the association between the increasing costs of these anticancer agents and the benefits they deliver to patients. These analyses call into question whether increased costs translate directly into improved survival or improved quality of life for patients.
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