Financial Toxicity of Healthcare: Cancer

Healthcare and drug costs have increased at rates unmatched by worker wages. As health spending of families with large employer health plans has increased at a rate twice as high as workers’ wages , the burden on the common man has risen to the extent that it is turning people away from getting the proper care they deserve (Rodriguez, 2019). This can be seen in both cancer patients and caretakers through research studies aiming to understand the long-term health implications of high healthcare costs.

Cancer is now considered the second most expensive disease in the U.S. The financial challenge it poses cannot go unnoticed (Abernethy & Zafar, 2013). Financial toxicity, problems that occur as a result of the cost of medical treatment, has serious implications. It has increased “psychosocial distress, diminished patient outcomes, and an overall poorer quality of life” for both the patients and caregivers (Snyder & Chang, 2019). Such effects can amplify the symptoms that patients come in with, creating this everlasting circle of suffering.

Even with adjustments for inflation, cancer therapeutics have risen at exponential rates, in the same way that we have seen pharmaceutical companies drive up the prices of lifesaving drugs. Arranon, a chemotherapy drug that targets certain kinds of lymphoma and leukemia, started at a price of $18,513/month in 2005 and has since increased by 55% after adjustment for inflation, whereas Torisol, a treatment for kidney cancer, has gone up by 24% from its price of $4,791/month in 2007 (Simon, 2007). And we all know that insurance companies are not going to cover these increasing costs; instead, these dues are pushed onto the patients and caregivers. Deductibles, the payment paid by the patient before the insurance company covers the rest, start to rise, and patients start to lose coverage for medication plans while getting charged higher copayments, the fixed price for a health service. It is an unfortunate form of “trickle-down” that no one should deal with. 

From the perspective of an hourly wage worker, increased costs will require these workers to work even more hours than their busy schedules already demand. And if these costs are coming from health-related issues, these workers won’t be able to meet this work demand, considering that they must take off from work to check on their health. They may need to take off work and could even risk losing their jobs. In the U.S., where health insurance is contingent upon one’s job, this only makes the situation worse. 

Stage 4 colon cancer patient Jim Lemieux has been charged $1,500 a month by his private insurance company to pay for the Avastin drug. In addition to the drug, he has medical bills for “hospitalizations, surgery, and co-payments for standard chemotherapy” , and the situation has gotten to the point where he and his wife have had to sell their house and live in their son’s basement (Kolata & Pollack, 2008). However, even this may not be enough to pay for all his bills, and so Lemieux may even have to resort to filing for bankruptcy. This is an unfortunate series of events that Limieux is not alone in going through as a consequence of their insurance companies leaving individuals with large shares of healthcare costs. 

Figure 1. The impact of the financial toxicity of cancer on various aspects of life.

Comparing these burdens between age groups under 65 and above 65, the impact is seen at a much higher extent among the younger population. These individuals don’t have as much savings or as stable an employment. It would take years, if not decades, in order to recover from such a financial dent on their records. Personal credit and savings are also hit drastically and patients and caretakers are left helpless. Consequently, it is no surprise that cancer patients are 2.65 times more likely to experience bankruptcy in comparison to patients without cancer (Chang & Snyder, 2019).

However, this issue does not just remain with  cancer patients and caretakers: it even impacts the treatment itself. Higher deductibles disincentivize lower income and uninsured patients from getting a diagnosis. In the chance that they have a serious illness, it would take them longer to find out. Data shows that among lower income women, there is a 1.6-month delay in breast imaging, 6.6 months in identifying early-stage breast cancer, and 8.7 months in having the first chemotherapy (Chang & Snyder, 2019). On the other hand, early detection could save a patient thousands of dollars in treatment and reduce their chances of death.

It is imperative that individuals get the care that they need, regardless of their background and income levels. There are people who are experiencing “unnecessary pain and suffering” at the hands of pharmaceutical companies, which provide limited justification of the absurd costs of cancer therapeutics (Kantarijian & Rajkumar, 2015, p.501), including citing increasing costs of research. The price tag of $1 billion has been spread around by pharmaceutical companies but this data has been debunked with a number that is “as low as 10% of the cited […] figure” (Kantarijian & Rajkumar, 2015, p.501). A comprehensive study of 99 cancer drugs, with 33 of those grossing over a $1 billion in revenue, showed that “by the end of 2017, median sales income across the 99 cancer drugs analyzed was $14.50 for every risk-adjusted R&D dollar invested” (Tay-Teo, Iibawi, & Hill, 2019). Running cost-benefit analysis testing on these drugs shows that the prices don’t match up with the impact the drug can have. Drugs of varied successes and benefits can still have the same price and get passed by the FDA. The National Comprehensive Cancer Network, which provides the guidelines for factors involved in the successful treatment of various types of cancers, has included affordability in its analysis of treatment and is working to target drugs that have high prices yet provide minimal assistance.

The steep incline in drug prices provides insight into the risks of placing minimal restrictions upon pharmaceutical companies. When profits and margins are prioritized, patients are left scrambling as they are forced to take out loans and resort to rationing out their limited drug stock. Skipping doses and avoiding costly drugs can lead to fatal results as symptoms continue to intensify.We have seen this issue with insulin in treatment for diabetes, which is now the most expensive chronic condition in the United States (Hayes, 2020). With the cost of rapid-acting insulin being 13.6 times costlier in the US than the average non-US price, people all across the country are advocating for government intervention, in hopes to reduce the prices (McGrail, 2016).

The financial toxicity of cancer has been a growing topic of interest for physicians across the world. Researchers are looking into the long-term repercussions on both patients and caretakers and whether intervening with mental health clinics, assistance with treatment pricing, and payment plans can help keep stress and concerns under control. Physicians are proposing the involvement of financial navigators, social workers, and training for oncologists in cancer economics so they can understand when one is experiencing financial toxicity (Desai & Gyawali, 2020). Now more than ever, it is imperative that society advocates for policy changes that encourage insurance companies to increase coverage and regulation of the cancer drugs that are coming into the market. By prioritizing profits and satisfying stakeholders, pharmaceutical companies have been capitalizing off of people’s misery for far too long.

References

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Desai, A., & Gyawali, B. (2020). Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine, 20, 100269. https://doi.org/10.1016/j.eclinm.2020.100269

Financial Toxicity (Financial Distress) and Cancer Treatment (PDQ®)–Patient Version. (2019, September 20). National Cancer Institute. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-pdq#_314

Hayes, T. O., & Farmer, J. (2020, April 2). Insulin Cost and Pricing Trends. American Action Forum. https://www.americanactionforum.org/research/insulin-cost-and-pricing-trends/#_edn1

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Kantarjian, H., Steensma, D., Rius Sanjuan, J., Elshaug, A., & Light, D. (2014). High Cancer Drug Prices in the United States: Reasons and Proposed Solutions. Journal of Oncology Practice, 10(4), e208–e211. https://doi.org/10.1200/jop.2013.001351

Kolata, G., & Pollack, A. (2008, July 6). Costly cancer drug offers hope, but also a dilemma. The New York Times. https://www.nytimes.com/2008/07/06/health/06iht-06avastin.14264136.html

McGrail, S. (2020, October 12). Insulin Prices 8x Higher in the US Compared to Similar Nations. Retrieved November 14, 2020, from 

https://pharmanewsintel.com/news/insulin-prices-8x-higher-in-the-us-compared-to-similar-nations

Rodriguez, A. (2019, August 26). Healthcare Costs Increased Twice as Fast as Worker Wages Over Last Decade. AJMC. https://www.ajmc.com/view/healthcare-costs-increased-twice-as-fast--over-last-decade

Simon, S. (2017, November 8). Study Shows US Cancer Drug Costs Increasing Despite Competition. American Cancer Society. https://www.cancer.org/latest-news/study-shows-us-cancer-drug-costs-increasing-despite-competition.html#:%7E:text=Drug%20prices%20increased%20an%20average%2018%25%20after%20inflation&text=After%20an%20average%20follow%2Dup,18%25%20after%20adjusting%20for%20inflation.

Snyder, R. A., & Chang, G. J. (2019, September 1). Financial toxicity: A growing burden for cancer patients. The Bulletin of the American College of Surgeons. https://bulletin.facs.org/2019/09/financial-toxicity-a-growing-burden-for-cancer-patients/

Tay-Teo, K., Ilbawi, A., & Hill, S. R. (2019). Comparison of Sales Income and Research and Development Costs for FDA-Approved Cancer Drugs Sold by Originator Drug Companies. JAMA Network Open, 2(1), e186875. https://doi.org/10.1001/jamanetworkopen.2018.6875

Zafar, S. Y., & Abernethy, A. P. (2015). Financial Toxicity, Part I: A New Name for a Growing Problem. Oncology (Williston Park, N.Y.), 27(2), 80–149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523887/