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Spending is up and mortality is down

Oncology Board Briefing
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The healthcare industry takes a lot of well-earned flack for cost, inefficiency, difficulty of use . . . I could go on, but I won't, because that industry also pays my mortgage. But here is one unambiguous, unalloyed win deserving of celebration: cancer mortality rates have declined by 33% since peaking in 1991, averting the deaths of more than 4 million people—thanks both to a successful stop-smoking campaign started a generation before the 1991 peak, plus massive advances in treatment over the past several decades. It is an achievement nothing short of stupendous, a monument to human drive and ingenuity, and a rare opportunity for me to write effusively and without hyperbole.

That's not to say that the struggle against cancer is anywhere near won. Colon and breast cancers alarmingly are appearing in ever-younger people, and the massive drop in screening during the pandemic has led to more patients presenting with advanced-stage cancers. And we still have huge disparities in outcomes by race, geography, and socioeconomic status. But even in these areas, oncology researchers, business leaders, policymakers, and politicians are increasingly prioritizing solutions. And they damn well better. Because cancer has become extremely expensive.

You're thinking: breaking news since forever, Christopher, thanks. Yes, cancer treatments have always been pricey, but the level of expense has changed dramatically in recent years—and it's poised to rise further and faster still. This week's Slides of the Week have been excerpted from this Thursday's Board Briefing (open to the public, so sign up if you haven't already).

Cancer has now overtaken orthopedics as the top health expense for employers, and end-of-life spending has become a massive Medicare cost, dwarfing nearly every other spending category. The past 20 years have seen great leaps forward in innovation resulting in the highest-cost drugs on the planet—treatments that are expensive not only to develop, but also to produce—and which are quite difficult to replicate (so don't necessarily expect biosimilars to come to the cost rescue).

And for all that clinical innovation, value-based payment innovation has lagged for one very good reason: no one wants to spend less money on cancer. And yes, value for money, things are artificially pricey, etc.—look, I know. But while value-based care rhetoric is quite persuasive for many types of care, cancer (mostly) isn't one of them, as any politician will attest. And if anything, President Biden's cancer moonshot is tailor-made to pour even more money into oncology. It is already by far the largest target for clinical investment, and it's where some of the most important clinical discoveries have been found. We have entire categories of treatment (which we helpfully outline in our slides today) that didn't exist two decades ago.

So what is the State of Oncology today? Swimming in clinical innovation, drowning in cost, awash in new investment, and woefully behind in payment innovation. The upshot is irritatingly simple: we will simply pay for it, or not pay for it. You don't have to be a gambler to know where to place your bets on this one. And there are at least 4 million people—and millions more friends and family members—who are grateful for it.

Tune in this week to learn where those dollars are getting spent, which clinical innovations have the most promise, who's poised to make money, and who's likely going to pay for it all.


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