new cancer drugs currently influence their decisions. Eighty-one percent agreed that patient out-of-pocket therapy costs influence their decisions, and a similar majority agreed that the costs of new cancer drugs would impose greater rationing in oncology in the next 5 years (Nadler et al., 2006). These answers seem to reveal a somewhat conflicted relationship with treatment costs among these oncologists, reflecting some of the challenges that oncologists currently face.

The same study posed a series of hypothetical scenarios to the oncologists surveyed. They were first asked to “Imagine a new cancer medication for treatment of metastatic lung cancer that on average costs $70,000 more than standard of care. At what minimum improvement in overall survival would you prescribe the new medication instead of the standard of care?” The distribution of responses is shown in Figure 6-1. Even though most surveyed oncologists agreed that costs should not affect care decisions, a majority required a minimum 2–4 months added survival to warrant the $70,000 expense. But there were a few at the extremes, such as one oncologist who would prescribe the medication for just one day of added survival. From the average minimum survival benefit required by these oncologists, Neumann and Nadler derived a mean cost-effectiveness threshold implied by the oncologists’ responses—$318,000 per life-year gained (Nadler et al., 2006). The authors concluded that oncologists’ cost-effectiveness threshold

FIGURE 6-1 Distribution of oncologist responses: hypothetical survival benefit needed to justify a treatment expense of $70,000.

SOURCES: Neumann presentation, February 9, 2009; Nadler et al., 2006.