The imperative to address the cost of oncology care.

Health-care spending in the United States accounts for approximately 18% of our economy, and per capita spending on health care far exceeds that of other industrialized countries. Yet, we are not necessarily spending wisely because by some measures we are no better off than other nations that spend far less. That said, most Americans are satisfied with their health care, and our collective decision (whether explicit or not) to prioritize health-care spending over other goods and services has resulted in important investment and innovation. For several decades, the growth rate in health expenditures exceeded overall growth of the economy, an unsustainable pattern (1). However, over the past 5 years, this growth rate has moderated, in part because of recession, decreased insurance payments, increased cost-sharing for patients, improved efficiencies, and slowdown in new innovations (2,3). Why, then, should we be concerned about the cost of providing care to our cancer patients, especially because cancer care accounts for a relatively small (approximately 5%) proportion of health-care expenditures? The answer is explained by economics but is rooted in morality. Insofar as receipt of cancer diagnosis and treatment is dependent upon availability of care, the high cost of care has the potential to widen disparities in cancer outcomes. Empirical data support this risk. The out-of-pocket expenses associated with cancer treatment are higher than with other chronic medical conditions (4). Whereas cancer patients are willing to tolerate higher out-of-pocket expenses for higher-value treatments, this elasticity in demand appears to vary depending on socioeconomic status (5,6). Empirical data support the hypothesis that out-of-pocket expenses affect the receipt of cancer therapy. As an example, adherence to oral cancer therapy is inversely related to copay level (7). A cancer diagnosis commonly exacts substantial financial burden on patients and families (8–10) and is associated with risk of bankruptcy (11). In short, rising costs of cancer care are forcing patients to make treatment decisions for life-threatening illness based on personal finances. This path is one that a just and moral society should aggressively seek to avert. In this issue of the Journal, Ramsey and colleagues build upon discussions from an Institute of Medicine workshop, " Delivering Affordable Cancer Care in the 21st Century, " and argue that " immediate action must be taken to avoid serious harm to the US economy and its citizens if we are to avoid a financial catastrophe " (12). The authors nicely highlight the ways …