Can Effective Cancer Care Become Affordable Again?

Scott Ramsey, MD, PhD

The Fred Hutchinson Cancer Research Center in Seattle recently announced the launch of a new research institute that it says is the first of its kind among national comprehensive cancer centers. It is called the Institute for Cancer Outcomes Research and Evaluation. The center will be dedicated to cancer outcomes research and health economics studies. We are speaking today with Dr. Scott Ramsey, the director of the new institute, professor of medicine, who has expertise in cost-effectiveness and economic studies for not just cancer but also diabetes, heart disease, and other prevalent diseases.

-Interviewed by Anna Azvolinsky, PhD

CancerNetwork: Dr. Ramsey, what is the goal of this new institute and why is its inauguration particularly timely?

Dr. Ramsey: The goal for our institute is to improve care, reduce variation and unwanted care, to lower costs for patients with cancer, and to also lower the burden of cancer to our healthcare system. I think it is particularly timely because cancer care delivery right now is in some crisis. At a time when we have excellent treatments and new treatments coming in line, the cost of those treatments are now becoming a tremendous burden for patients. We, at our institute, have collected research showing patients with cancer are going bankrupt at unprecedented levels and many are experiencing severe financial strain. And for this reason we feel that the promise of cancer care is now being threatened by the cost of cancer care. It is our goal at this new institute to try to reduce that trend.

CancerNetwork: So you touched upon this already but maybe go into more detail why you think health economics particularly important now especially for cancer care?

Dr. Ramsey: Well, the economics of cancer are such that the cost of treating patients is going up, really exponentially. Chemotherapy regimens for cancer that 10 years ago cost $30,000 are now costing $200,000. There are new surgery and radiation therapy techniques that are very, very expensive and are often introduced into the marketplace without knowledge that they are incrementally better than less expensive alternatives. So we think health economics can help identify high-value cancer therapies and to encourage the use of these high-value therapies and reduce the use of low-value therapy so that everyone can afford care when they cancer.

CancerNetwork: Can you describe the type of research that will be done and also the key stakeholders, payers, or patient advocacy groups, for example?

Dr. Ramsey: So our stakeholders include the payer community-the health insurers who pay for the care. The delivery systems that provide the care-the clinics, the hospitals, and related services. We hope to involve patient advocates so that they can have a voice in this new initiative. And we expect there to be a role for the government in helping to facilitate improvements in care. The type of research we are going to do is focusing on collecting information from a variety of sources that are currently in silos. There are health insurance records, there is a cancer registry in our state that collects data on almost every cancer patient, and there is now a growing number of practices that have electronic medical records. Unfortunately all of that information is in silos and is not connected in a way that we can get a good picture of the patient’s experience from their diagnosis onward. That will be one of the major efforts of our center so that we can collect that and look at patterns of care and identify areas where the care is not ideal and report that back to everyone so that care can improve.

CancerNetwork: So is that one of the reasons why this institute is unique, because that hasn’t happened before, the integration of these different data sources?

Dr. Ramsey: Yes, that has never been attempted, and this institute is the first of its kind in a comprehensive cancer center that is devoted to this particular problem. And so we are doing this based on years of experience and a collaborative spirit that we have here in Washington among all of our stakeholders and our optimism that that collaborative spirit will make this type of database possible so that patient care can be improved.

CancerNetwork: From my understanding, the institute will evaluate the cost effectiveness of various therapies, technologies, and procedures within the state of Washington. Will there be an open dialog with other comprehensive cancer centers across the United States, and is there a long-term goal to extend this research to a national level?

Dr. Ramsey: Well, there is a saying that all politics is local, and we actually think that all cancer care is local too. We are certainly focusing our efforts on Washington State because we believe that it is feasible to do the changes we are hoping for at the state level. But that said, we hope the model that emerges from our institute will translate to other cancer centers, other comprehensive cancer centers, even other community cancer centers that are interested in the same goals that we have.

CancerNetwork: So potentially long term, there is a hope that your institute will maybe serve as a model for a national coalition on health economics?

Dr. Ramsey: We hope that the work we do in terms of collecting information on cost and outcomes so that we can identify the most cost-effective care as it is practiced in the community. We hope that model can be translated nationally but it will have to be implemented at every local region so there will be some variation from region to region depending on the systems and the cultures of the region. That said, the issue of collecting information is the critical piece. Currently, only 3 out of 100 patients who have cancer who are adults get enrolled in a clinical trial, and the other 97 out of 100, that information is wasted, their entire clinical experience is in these silos, is in these records that never get shared and are not available for research. So we believe that is one of the biggest impediments to research and one of the reasons we are working towards this goal of collecting all of this siloed information.

CancerNetwork: Just as a final question, there has been a lot of talk about comparative effectiveness research and there has been funding for this at the national level. So is there any other way that you have not mentioned already, how your approach will be unique in terms of this type of research?

Dr. Ramsey: Well, the other thing that I think is important to understand, is that as a resource, we are providing a service. And a part of the service is to provide information to researchers that they have never had before on large numbers of patients. But the other part of the service is to provide information to patients, healthcare payers, and physicians about how cancer care is being delivered in the region so that care can be improved. We believe that the information is very powerful if that information can be presented in the right way. For that reason, the model is a little different than a research model. We will also have a service model and that will be a way that we will support ourselves, providing services that have value in this area.

CancerNetwork: OK, thank you so much for joining us Dr. Ramsey, we look forward to the research that comes out of the Institute for Cancer Outcomes Research and Evaluation, thank you.

Dr. Ramsey: OK, thank you, bye.