Managing the Financial Impact of Cancer Treatment: The Role of Clinical Practice Guidelines

The rising cost of cancer treatment in the United States poses a significant challenge to health systems, government and private insurers, and individual patients. To some degree, cancer treatment costs are rising due to inappropriate, non-evidence-based use of expensive new technologies and drugs. However, adherence to evidence-based clinical practice guidelines does not necessarily guarantee that cancer treatment will be less costly or optimally cost-effective. Although clinical practice guidelines may endorse many acceptable evidence-based treatment options, the financial implications of different treatment decisions within these guidelines can vary significantly. In the case of first-line treatment for metastatic colorectal cancer (CRC) and gastric cancer, for example, the cost of 6 months' treatment varies widely while the clinical effectiveness of these regimens is comparable. Patients' out-of-pocket payments for various treatment regimens may also vary significantly. In the setting of rapidly rising cancer treatment costs, it is essential that clinical practice guidelines begin to incorporate economic information from the patient and health system perspectives to minimize the financial impact of cancer care on patients and society.