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During the past decade, the price of cancer drugs and the spending for cancer treatments by Medicare have increased dramatically. The author outlines the usual tools Medicare uses to control its spending on drugs and discusses the policies that make cancer drugs a special case and prohibit the regulation of their prices and utilization. The price of cancer drugs and the spending for cancer treatments by Medicare have increased dramatically. Dr. Peter Bach outlines the usual tools Medicare uses to control its spending on drugs and discusses the policies that make cancer drugs a special case and prohibit the regulation of their prices and utilization. Fifteen years ago, the only commonly used cancer drug on the market that cost more than $2,500 per month was paclitaxel (Taxol, Bristol-Myers Squibb), which Chabner and Roberts labeled the first cancer “blockbuster.” 1 Today, cancer drugs that come on the market routinely cost many times that amount (Figure 1). Several established cancer drugs have recently seen price increases, which has added to the general upward trend in prices. Nitrogen mustard, a drug that has been used to treat cancer since 1949, saw its price for a course of treatment increase by a factor of 13 between the beginning and the . . .

With more expensive drugs being introduced, some of them for highly prevalent conditions, and the pace of generic conversion slowing, policymakers may want to consider cost-effectiveness analyses for coverage decisions — but there would still be a budgetary problem. Nowadays, the reality of exorbitant drug pricing overshadows even the most exceptional stories of drug efficacy. It's true that we're making huge biomedical strides, yet it's also true that prices for new drugs are rising, as are prices of existing treatments. A case in point is nivolumab, which, as Motzer et al. report in this issue of the Journal (pages 1803–1813), appears to extend median survival in patients with metastatic renal-cell cancer by nearly half a year. But the cost to insurers and patients of using the drug for this condition — by my estimate, around $65,000 for Medicare beneficiaries . . .

Even if CMS concludes that CAR-T therapy provides a net benefit for Medicare patients, it could limit who can provide the therapy, require collection of further outcome data, limit coverage to clinical trials, and design a payment approach promoting price competition.

In 2011, Bristol-Myers Squibb set the price of its newly approved melanoma drug ipilimumab—brand name Yervoy—at$120,000 for a course of therapy. The drug was associated with an incremental increase in life expectancy of four months. Drugs like ipilimumab have fueled the perception that the launch prices of new anticancer drugs and other drugs in the so-called “specialty” pharmaceutical market have been increasing over time and that increases are unrelated to the magnitude of the expected health benefits. In this paper, we discuss the unique features of the market for anticancer drugs and assess trends in the launch prices for 58 anticancer drugs approved between 1995 and 2013 in the United States. We restrict attention to anticancer drugs because the use of median survival time as a primary outcome measure provides a common, objective scale for quantifying the incremental benefit of new products. We find that the average launch price of anticancer drugs, adjusted for inflation and health benefits, increased by 10 percent annually—or an average of $ 8,500 per year—from 1995 to 2013. We argue that the institutional features of the market for anticancer drugs enable manufacturers to set the prices of new products at or slightly above the prices of existing therapies, giving rise to an upward trend in launch prices. Government-mandated price discounts for certain classes of buyers may have also contributed to launch price increases as firms sought to offset the growth in the discount segment by setting higher prices for the remainder of the market.

Nature-based solutions (NBS) harness ecosystem services for urban enhancement, promoting biodiversity, habitat creation, and water management while improving human well-being. However, decision-making often favours specific NBS designs, leading to uneven benefits distribution. Whereas human-centric NBS design relies on convenience, financial sustainability, historical aspects, and amenity increase through NBS technical solutions, flora- and fauna-centric (or eco-centric) design targets spatial connectedness of blue-green spaces, increase in species richness, and habitat within urban centres. Both approaches can shape the urban biodiversity landscape, yet; they often clash around planning priorities. Recent advances in AI offer potential for AI-centric urban planning, though its role remains unclear. This study examines the interplay between biodiversity and NBS planning across human-, eco-, and AI-centric domains, aiming for balanced urban outcomes. We blended narrative, integrative, and systematic literature review and propose future steps for more balanced NBS development. The findings of this work suggest that AI presents an opportunity for a more balanced NBS design through its applications in climate change prediction, water management, and project visualisation. Incorporating AI into urban planning tools can expedite modelling process, improve stakeholder communication, and enhance project outcomes visualisation. By integrating human, eco, and AI-centric approaches, urban planners can foster resilience and sustainability in NBS implementation, ensuring equitable distribution of benefits across urban landscapes.

By negotiating prices only for drugs that have too little evidence to support full approval or are too late in their life cycle to justify continued high prices, Medicare could both deliver substantial savings and preserve the incentive framework for innovation.

AbstractObjectiveTo identify all known ties between the medical product industry and the healthcare ecosystem.DesignScoping review.MethodsFrom initial literature searches and expert input, a map was created to show the network of medical product industry ties across parties and activities in the healthcare ecosystem. Through a scoping review, the ties were then verified, cataloged, and characterized, with data abstracted on types of industry ties (financial, non-financial), applicable policies for conflict of interests, and publicly available data sources.Main outcome measuresPresence and types of medical product industry ties to activities and parties, presence of policies for conflict of interests, and publicly available data.ResultsA map derived through synthesis of 538 articles from 37 countries shows an extensive network of medical product industry ties to activities and parties in the healthcare ecosystem. Key activities include research, healthcare education, guideline development, formulary selection, and clinical care. Parties include non-profit entities, the healthcare profession, the market supply chain, and government. The medical product industry has direct ties to all parties and some activities through multiple pathways; direct ties extend through interrelationships among parties and activities. The most frequently identified parties were within the healthcare profession, with individual professionals described in 422 (78%) of the included studies. More than half (303, 56%) of the publications documented medical product industry ties to research, with clinical care (156, 29%), health professional education (145, 27%), guideline development (33, 6%), and formulary selection (8, 1%) appearing less often. Policies for conflict of interests exist for some financial and a few non-financial ties; publicly available data sources seldom describe or quantify these ties.ConclusionsAn extensive network of medical product industry ties to activities and parties exists in the healthcare ecosystem. Policies for conflict of interests and publicly available data are lacking, suggesting that enhanced oversight and transparency are needed to protect patient care from commercial influence and to ensure public trust.

The Institute of Medicine (IOM) recommends the use of survivorship care plans (SCPs) for all cancer survivors. Developing useful SCPs requires understanding what survivors and their providers need and how SCPs can be implemented in practice. Published studies investigating the perspectives of stakeholders (survivors, primary care providers, and oncology providers) were reviewed regarding the content and use of SCPs. All National Cancer Institute (NCI)-designated cancer centers were surveyed concerning the extent to which SCPs for survivors of breast and colorectal cancers are in use, their concordance with the IOM's recommendation, and details about SCP delivery. Survivors and primary care providers typically lack the information the IOM suggested should be included in SCPs. Oncology providers view SCPs favorably but express concerns about the feasibility of their implementation. Fewer than one-half (43%) of NCI-designated cancer centers deliver SCPs to their breast or colorectal cancer survivors. Of those that do, none deliver SCPs that include all components recommended by the IOM. Survivors' and providers' opinions about the use of SCPs are favorable, but there are barriers to implementation. SCPs are not widely used in NCI-designated cancer centers. Variation in practice is substantial, and many components recommended by the IOM framework are rarely included. [PUBLICATION ABSTRACT]

Rapid advancements in the area of early cancer detection have brought us closer to achieving the goals of finding cancer early enough to treat or cure it, while avoiding harms of overdiagnosis. We evaluate progress in the development of early cancer detection tests in the context of the current principles for cancer screening. We review cell-free DNA (cfDNA)-based approaches using mutations, methylation, or fragmentomes for early cancer detection. Lastly, we discuss the challenges in demonstrating clinical utility of these tests before integration into routine clinical care.

The high cost of cancer care worldwide is largely attributable to rising drugs prices. Despite their high costs and potential toxic effects, anticancer treatments could be subject to overuse, which is defined as the provision of medical services that are more likely to harm than to benefit a patient. We found 30 studies documenting medication overuse in cancer, which included 16 examples of supportive medication overuse and 17 examples of antineoplastic medication overuse in oncology. Few specific agents have been assessed, and no studies investigated overuse of the most toxic or expensive medications currently used in cancer treatment. Although financial, psychological, or physical harms of medication overuse in cancer could be substantial, there is little published evidence addressing these harms, so their magnitude is unclear. Further research is needed to better quantify medication overuse, understand its implications, and help protect patients and the health-care system from overuse.