Challenges U.S. and U.K. cancer patients face in gaining access to expensive treatments

Cancer patients in both the United States and the United Kingdom face challenges in gaining access to expensive treatments, according to research published in the December issue of The Milbank Quarterly.

"There seem to be a lot of generalizations as to the worse availability of such drugs in the United Kingdom, compared to the United States," said study co-author Kalipso Chalkidou, M.D. "We wanted to take a serious look at what claims one can make based on evidence rather than preconceived ideas."

Chalkidou is director of the international program at the National Institute for Health and Clinical Excellence in London. She and U.S.-based lead author Ruth Faden, Ph.D., at the Johns Hopkins Berman Institute of Bioethics, compared the cost and availability of 11 drugs used to treat a variety of cancers, focusing on those costing between $8,700 and $32,000 for a three-month supply.

For seven of the 11 expensive cancer drugs examined, British patients pay no out-of-pocket costs. In comparison, U.S. patients, even those with Medicare coverage, pay out-of-pocket costs ranging from $1,200 to $24,000, depending on the length of their treatment.

U.S. patients without insurance pay even more, and because cancer patients often take more than one drug, their out-of-pocket costs could soar higher, the authors reported. However, for the other four drugs in the study, the U.K.'s National Health Service pays nothing, whereas U.S. Medicare plans offer at least some coverage for all 11 drugs.

Chalkidou noted that lack of reliable data made it difficult to conduct meaningful comparisons on price, access and affordability for U.S. and U.K. cancer patients. "Both systems have to make tough choices and neither is perfect. However, based on our analysis, it seemed to us that the way decisions are made in the United Kingdom tends to be more predictable, consultative and transparent than in the United States," she said.

In the United Kingdom, national and local governments and clinicians use published criteria to make judgments about covering the costs of treatment with expensive cancer drugs.

Treatment for American cancer patients, on the other hand, often depends not on the government or doctors' decisions, but on their health insurance coverage and their personal financial resources, the authors wrote.

"It's important to see that there are strengths and weaknesses to all allocation systems — either public or private," said Kevin Schulman, M.D., an expert in economic evaluation in clinical research and professor of medicine and business administration at Duke University. He has no affiliation with the study.

"There are different social constructs underlying these two systems. The British clearly struggle with the potential for people to have more access than is equitable. In the United States, we accept this inequity without question, and then struggle with its consequences," he said.