Rising drug prices and national expenditures are receiving increasing attention after 2018 yielded a record 59 novel drug approvals by the US Food and Drug Administration (FDA). In the US, cancer drug spending has grown 12% to 15% annually and is projected to continue on this trajectory in the coming years. Cancer drug spending outpaces spending in other common sectors with growth of 3.3% for all prescription drugs and 4.4% for hospital spending in 2018. For 2020 through 2027, US prescription drug spending is projected to grow 6.1% annually. Many factors contribute to the exceptional growth in cancer drug spending, including changing demographics, improved survival, and rising drug prices.

Currently, 35% of the drug development pipeline is dedicated to cancer drugs—a 30% increase over the past decade. The increasing interest in the development of anticancer therapeutics is presumably a product of technologic advances and perceived financial opportunity for manufacturers. Marketing authorization for a new cancer drug can yield a significant financial return irrespective of the clinical benefit demonstrated in pivotal trials with median launch price more than $100, 000 per treatment course...