ACA on the Brink of Extinction ?
A Healthy Report Card
CLL-imbing Prices Means Ineffective Agents
CLINICAL NEWS
ACA on the Brink of Extinction ?
The Affordable Care Act ( ACA ) may be in the process of being repealed , but results from the Kaiser Family Foundation ’ s last “ Kaiser Health Tracking Poll ” of 2016 found that , after the election , the majority of President Trump ’ s supporters have favorable views of many of the health-care law ’ s provisions :
Allowing young adults to stay on their parents ’ insurance plans until age 26 :
83 %
Eliminating out-of-pocket costs for many preventive services :
75 %
Creating health insurance exchanges to compare prices and benefits :
72 %
Closing the Medicare prescription drug coverage gap :
71 %
Providing Medicaid expansion option to cover more lowincome , uninsured adults :
66 %
Most voters ( across party lines ) agreed that repeal of the ACA would not affect their health-care access ( 57 %), but attitudes about the potential replacement plan are split . ( For more about health care under the Trump presidency , see our Feature article on page 30 .)
Source : Kaiser Family Foundation ’ s “ Kaiser Health Tracking Poll : November 2016 ,” December 1 , 2016 .
A Healthy Report Card
According to the American Cancer Society ’ s latest “ Cancer Statistics ” report , this year ’ s cancer-related mortality rate is expected to be 25 percent lower than 25 years ago .
In 2017 :
• an estimated 1,688,780 people are expected to be diagnosed with cancer
• an estimated 600,920 people are expected to die from cancer
That ’ s approximately 2,143,200 fewer cancer-related deaths than would have been expected if death rates had remained at 1991 levels .
What ’ s responsible for this good news ? In large part , better treatment protocols and more targeted therapies for blood cancers , the researchers reported .
Source : Siegel RL , Miller KD , Jemal A , et al . Cancer statistics , 2017 . CA Cancer J Clin . 2017 ; 67:7-30 .
CLL-imbing Prices Means Ineffective Agents
Oral targeted therapies are a significant advance for patients with chronic lymphocytic leukemia ( CLL ), but their high prices means they will be incredibly cost-ineffective .
In a study examining the economic impact of newer agents ( such as ibrutinib and idelalisib ) as firstline treatment for CLL patients , researchers projected , from 2011 to 2025 :
People living with CLL |
200,000
150,000
100,000
50,000
|
Annual cost of CLL management |
6
5
4
3
2
1
|
Per-patient lifetime cost of CLL treatment
$ 800,000 $ 700,000
$ 600,000 $ 500,000
$ 400,000 $ 300,000
$ 200,000 $ 100,000
|
Out-of-pocket Medicare costs
$ 60,000
$ 50,000
$ 40,000
$ 30,000
$ 20,000
$ 10,000
|
0
2011
a 55 % increase in the number of people living with CLL ( 128,000 to 199,000 )
0 $ 0
$ 0 2025 2011 2025 2011 2025 2011
2025 a 590 % increase in annual cost of CLL management ($ 0.74 billion to $ 5.13 billion ) a 310 % increase in per-patient lifetime cost of CLL treatment ($ 147,000 to $ 604,000 ) a 520 % increase in out-of-pocket costs for Medicare patients ($ 9,200 to $ 57,000 )
“ Such an economic impact could result in financial toxicity , limited access , and lower adherence to the oral therapies , which may undermine their clinical effectiveness ,” the researchers wrote . “ A more sustainable pricing strategy is needed .”
Source : Chen Q , Jain N , Ayer T , et al . Economic burden of chronic lymphocytic leukemia in the era of oral targeted therapies in the United States . J Clin Oncol . 2017 ; 35:166-74 .
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