The Complex Calculations of Cancer Care
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The cost of diagnosing and treating cancer is soaring, but defining overutilization and calculating ROI can be a challenge.
Editor’s note: This is the second in a three-part series on how technology impacts the cost of healthcare. The July article focused on imaging technology. The September article will explore the cost and efficacy of remote healthcare technologies such as remote ICUs.
Cancer care is often considered a culprit in the rising cost of healthcare in the United States. But it is also perhaps the best example to illustrate the many barriers that prevent getting those costs under control. First, there has been rapid advancement in the technologies, procedures, and medications used to diagnose and treat the disease—one more expensive than the next.
Second, cancer is so emotionally charged that even the hint of a possibility of a diagnosis of cancer can put patients in a panic, driving demand for those expensive tests and procedures. Third, while no physician wants to get any diagnosis wrong, the consequences of missing cancer are particularly high, a contributing factor to overutilization.
Meanwhile, hospitals that invest in high-cost cancer technologies do not do so lightly. It is, they argue, not only critical to their mission of offering patients the best possible care, but it is also a business imperative.
“Until we’re able to really get to a point where we’re curing the vast majority of our patients with minimum side effects, I think we have to keep pushing the envelope. And there’s different ways to push it, and people are going to have different opinions on how best to push it, but I don’t really personally understand this debate on overdiagnosing cancer. If you have cancer you have cancer,” says Anurag Agarwal, MD, chief of radiation oncology at Broward Health, a seven-hospital integrated system in Fort Lauderdale, FL. “We talk about healthcare expenses, but you have to look at what’s the better alternative. It’s easy to identify a problem, but it’s harder to come up with a solution.”
The cost of cancer care
The cost of cancer treatments ranges from the relatively inexpensive “watchful waiting” to chemotherapy drugs that can cost thousands of dollars per 10-day treatment cycle to stereotactic radio surgery systems that cost hundreds of thousands of dollars. And then there’s the massive nuclear particle accelerators used for proton beam therapy and the physical plants needed to house them, which can cost hundreds of millions of dollars to build, deploy, staff, and maintain. (Although at presstime there were only seven proton centers in the country, six more are under development, according to the National Association for Proton Therapy.)
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