Tracking Discussions About Costs and Oncology at the “Unofficial” ASCO

There are, in some ways, two overlapping American Society of Clinical Oncology annual meetings each year. There is the official one, dominated by spectacular research presented before enormous crowds in cavernous halls at McCormick Place. And there is the unofficial meeting, where old colleagues and new friends swap stories.

The first meeting gets a lot of coverage, but the second meeting can be even more important. It’s where the reality of oncology care really gets hashed out. And this year, we expect that unofficial ASCO will have a far larger focus on the cost of oncology care than the official confab.

In the United States, the influx of truly remarkable cancer therapies has created a corollary issue. Spending on oncology medicines, according to IQVIA, is up more than threefold in the past decade. IQVIA expects to see spending grow another 50% in the next five years. Optimists will claim that reflects a slowing growth rate. Pessimists will note that the IQVIA 2025 estimate is more than $100 billion dollars, dollars that might otherwise be spent on other health care or social priorities.

And it’s not clear that the United States is getting great value for the money invested in oncology care. A JAMA Health Forum piece out last weekend showed that the United States spends about twice the median spending in 21 other high-income countries, with middle-of-the-pack mortality rates.

This reality lies atop a quiet crisis at the patient level. Individuals are also facing increasing costs. One study, to be presented on Saturday, found that out-of-pocket spending on oral oncology medicines, for patients who reach the catastrophic phase of Medicare Part D, more than quadrupled between 2011 and 2016. Another presentation on the docket for Saturday found that patients in high-deductible health plans have higher mortality rates, likely because of the impact on cost-sharing.

Those are the realities that will drive those conversations at unofficial ASCO, and they are realities that all parts of the health care system would be wise to prepare for. Some of the solutions are increasingly ripe. Biosimilars are grabbing meaningful market share and beginning to bend the cost curve (if less dramatically than generic small-molecule drugs do).

Other solutions are less established but have the potential to grab attention, even if the impact is further in the future. Low-cost, fast-follow medicines with disruptive pricing – some built off of efficient development programs in China – may offer competition on prices. And value-based contracts could offer a path forward, even if existing efforts are often dismissed as both too modest and too complex. The idea of linking what’s paid to what is received is simply too attractive to wither, especially to unofficial ASCO attendees.

None of this should take away from the clinical breakthroughs that we’ll hear about over the days to come. The question is not whether today’s cancer drugs are miracles – they are – but rather how the system can evolve, and must evolve, to make sure that those miracles, and the miracles to follow, reach the masses.