TT: patient base expands beyond payment capacity?

According to a new report from Decision resources: "targeted cancer therapies are expanding the oncology market by increasing the age limit for treatment....., more than 80% of oncologists say that the availability of targeted cancer therapies is increasing the number of elderly patients who they treat; 64% of these respondents state that the increase is due to fewer side effects associated with targeted agents compared with chemotherapy.

Hmm....time to expand those market projections

But....

Access is an emerging problem:

"Nearly one-fifth of office-based oncologists are planning to limit treatment of Medicare patients in the next 12 months.

Office-based oncologists report that 16% of their Medicare patients who are candidates for targeted therapies fail to undergo treatment for cost- related reasons, most frequently because the patient cannot afford the copayment or coinsurance," said Mary Argent-Katwala, Ph.D., analyst at Decision Resources. "The extent of this problem varies between therapies: oncologists estimate that 10% of eligible patients fail to receive Avastin because patients cannot afford the copayments or because the drug is not available on the formulary for the desired use; for Sutent, the corresponding figure is 52%."

Wow.


2 issues:

Reimbursement: I wonder if the difference in uptake between Sutent and Avastin is largely explained by Avastin's ~15 month earlier FDA approval, meaning that the drug has had enough time to be added to most formularies. (Or is it the difference between options available to treat CRC (Avastin) vs RCC (Sutent.))

Patient opt-out for treatment based on $$$: I'd be real curious to know if this is an example of patient self-rationing (i.e. they don't see a good cost/benefit return for Avastin or Sutent extending life by a few months), or, is this a consequence of American's poor savings habits, as there is interest in treatment, but no cash available?