Thursday, December 2, 2010

Healthcare crisis in microcosm

This article from provides a glimpse into why the cancer care delivery system, which I've harshly critiqued in earlier posts, is in such peril. It's important to note that the story is based exclusively on a press release from the Clinical Oncology Alliance, a provider advocacy group. I've read that the cost of treating cancer has more than doubled in the last 20 years, which comes as no surprise given the often extraordinary expense of new drugs and therapies that have emerged in that time. The concept of community-based cancer care wouldn't exist if reimbursements and other financial incentives hadn't allowed it. Perhaps it's a luxury we can't afford.

The crisis in our healthcare system is playing out in microcosm here: insatiable demand for increasingly sophisticated cancer care colliding with the brutal necessity of reigning in out-of-control costs. One example: The company that maufactures the new monoclonal antibody drug for advanced melanoma, ipilimumab, hasn't yet set a price, but it's expected that ipi will cost thousands of dollars per month for patients who need it. Should Medicare, which covers about half of all cancer patients, approve its reimbursement? It appears it soon will. Another question: Are patients receiving ipi or other new biotech drugs best managed in the community setting, or at big-city tertiary sites only, where it may be possible to capture efficiencies of scale and where clinical talent and resources can be concentrated. I'm inclined to go with the latter, but much depends on the mobility of the patient and other factors. This question won't matter, of course, if your local cancer clinic has shut down. Based on my experience, that's not the worst thing that could happen.

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