Earlier diagnosis, longer treatment duration and increased effectiveness of drug therapies are contributing to rising levels of spending on medicines for cancer care, according to a new report released by the IMS Institute for Healthcare Informatics, a global information and technology services company based in Parsippany, N.J. The report stated total global spending on oncology medicines—including therapeutic treatments and supportive care—reached the $100 billion threshold in 2014, even as the share of total medicine spending of oncologics increased only modestly.
Growth in global spending on cancer drugs—measured using ex-manufacturer prices and not reflecting off-invoice discounts, rebates or patient access programs—increased at a compound annual growth rate (CAGR) of 6.5% on a constant-dollar basis during the past five years. Oncology spending remains concentrated among the U.S. and five largest European countries, which together account for 66% of the total market, while the rising prevalence of cancer and greater patient access to treatments in pharmerging nations continues to grow and now accounts for 13% of the market.
Targeted therapies have dramatically increased their share of the total global oncology spend, rising 14.6% CAGR during the past five years with steady increases across all regions. At the same time, payers and national health systems have intensified their scrutiny of the value of these medicines relative to their incremental benefits over existing treatments, with cost effectiveness assessments frequently resulting in limited patient access to these drugs. Access and reimbursement issues are likely to become more complicated in coming years as individual and combination oncology medicines address multiple cancer types and patient populations with varying dosage and clinical value.
“The increased prevalence of most cancers, earlier treatment initiation, new medicines and improved outcomes are all contributing to the greater demand for oncology therapeutics around the world,” said Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics. “Innovative therapeutic classes, combination therapies and the use of biomarkers will change the landscape over the next several years, holding out the promise of substantial improvements in survival with lower toxicity for cancer patients.”
The report found that the global oncology market continues to experience steady growth. The global market for oncology drugs, including those used in supportive care, increased 10.3% in 2014 and reached $100 billion, up from $75 billion five years earlier. The compound annual growth rate in spending over the past five years has been 6.5% globally on a constant exchange rate basis. Growth in the U.S. has risen more slowly at 5.3% CAGR, reaching $42.4 billion in 2014. Oncology drug spending has risen slightly as a percentage of total drug spending over the past five years in all regions, most notably in the EU5 countries where oncology now represents 14.7% of total drug spending, up from 13.3% in 2010. Within the U.S., the increase has been more modest, rising to 11.3% from 10.7% over the same period. Targeted therapies now account for nearly 50% of total spending and have been growing at 14.6% CAGR since 2009.
Clinical outcomes are improving for major cancers. According to the report, in most instances, five-year survival rates have risen through continuous and small improvements in detection and treatment—including refinements with existing treatments and gains from new treatment options. Within the U.S., two-thirds of Americans diagnosed with cancer now live at least five years, compared to just over half in 1990. The strong pipeline of medicines in clinical development include new “immuno-oncologics” that hold out the promise of improved survival with lower toxicity for some patients, as well as combination therapies that can address multiple pathways in a tumor, potentially leading to substantial increases in survival. Additionally, therapeutic effectiveness in multiple genetic subpopulations is being improved through the use of real-world evidence from deep biomarker data linked to treatment information. Molecular diagnostics are rapidly transforming drug development and patient selection, but only one-third of new oncology drugs have an identified biomarker at time of launch.
Patient access to cancer drugs varies across all markets, said IMS Health. The availability of new oncology medicines varies widely across the major developed countries, with patients in Japan, Spain and South Korea having access in 2014 to fewer than half of the new cancer drugs launched globally in the prior five years. In pharmerging markets, availability of newer targeted therapies remains low but is increasing. Even among wealthy countries, new drugs may not be reimbursed and, as a result, will only reach a very small number of patients. Average therapy treatment costs per month have increased 39% in the U.S. over the past 10 years in inflation-adjusted terms. Over the same period, patient response rates have improved by 42% and treatment duration has increased 45%, reflecting improved survival rates. Within the U.S., patient out-of-pocket costs have risen sharply for intravenous cancer drugs, increasing 71% from 2012 to 2013, reflecting changes in plan designs and increased outpatient facility costs.
Patients are engaging social media and online networks throughout their cancer journey. Public discussion boards, followed by Twitter, are the most dominant channels used by patients during their cancer journey as they proactively engage on a wide range of topics including conversations regarding treatment options and financial concerns. In a six-month assessment of social media discussions related to prostate cancer, the most frequent topic of discussion was treatment options, followed by financial concerns, said the report.