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Oncologists inconsistent in how they judge value of high-cost cancer drugs Posted 27/04/2012

A survey of oncologists in Canada and the US has shown that physicians are inconsistent when deciding how long an expensive new cancer therapy should extend a person’s life before the cost of the therapy is justified. The results of the survey also showed the benefit that oncologists demand from new treatments in terms of length of survival does not necessarily increase according to the price of the treatment [1].

The survey, published in the April 2012 issue of Health Affairs, asked ‘how much benefit, in additional months of life expectancy, a new drug would need to provide to justify its cost and warrant its use in an individual patient’ and was answered by 788 US and 158 Canadian oncologists.

About 50% of the oncologists said that a cancer treatment should cost US$50,000 to US$100,000 per life-year saved, which is what ‘most cost-effectiveness experts usually endorse’, according to Dr Ubel and co-authors. However, when questioned about the hypothetical case of an individual patient with metastatic cancer most oncologists also endorsed a ‘much higher cost-effectiveness ratio, often several hundred thousand dollars per life-year gained’.

The survey shows oncologists endorsed a cost-effectiveness ratio of US$250,000 per life-year gained when presented with the US$150,000 drug.

The inconsistencies in the required benefit for an expensive new cancer treatment were found by the authors to be ‘not entirely surprising’, and were attributed to the fact that ‘most physicians have very little training in how to factor cost-effectiveness information into their decision making.’

The authors believe that the findings suggest that ‘policymakers should find ways to improve how physicians are educated on the use of cost-effectiveness information’ and ‘to influence physician decision making through clinical guidelines that incorporate cost-effectiveness information’.  The author suggests that policymakers ‘may need to take more of a leadership role in determining affordability’, rather than ‘leaving these decisions to individual physicians’.


1.  Ubel PA, et al. In A Survey, Marked Inconsistency In How Oncologists Judged Value Of High-Cost Cancer Drugs In Relation To Gains In Survival. Health Aff. April 2012;31(4):709-17.

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