Insurers have emphasised that healthcare providers such as hospitals and clinics need to be properly held to account for the success of their cancer treatments as costs spiral.
They highlighted the importance of greater data collection and analysis on treatment outcomes and questioned if outcomes were improving at the same rate as price rises.
Representatives from Aviva and Healix Health told the Association of Medical Insurers and Intermediaries (AMII) health and wellbeing summit that proper benchmarking of providers was required as well as effective interrogation of data to discover whether customers were getting bang for their buck.
Cancer drug costs surge
Dr Roshane Mohidin, associate medical director at Aviva, told delegates that cancer spending was a high cost area which had surged over the last five years.
“We’re seeing from a drugs perspective that spend has been increasing and has grown 75% over the last five years and it’s looking like it will continue to grow,“ he said.
“But the prediction is by 2027 this will plateau due to generic or similar competition so there will be similar drugs or drugs that do the same thing which will potentially mean that the costs will be driven down.”
However, Dr Mohidin added that while innovations on cell and gene therapies were further contributing to drug spend, research was indicating improvement in patient outcomes were not always advancing in line with cost increases.
“What I found interesting was a report on how effective the treatments were versus the costs and what they found is that the benefits were at 20%,” Mohidin continued.
“What that’s suggesting is although the cost of the treatment is increasing, the outcomes themselves are not necessarily in line with that.”
Embedding data intelligence
Picking up the same point in a later session, Healix Health director of corporate proposition Sarah Taylor (pictured) told delegates the private medical insurance sector must embed data intelligence when it comes to cancer costs.
“If we don’t, then that year-on-year inflation which is currently being quoted at around 9% is going to carry on year-on-year-on-year,” Taylor said.
“That means by 2030 it is going to be huge – probably 50% higher than it is.
“What we need to understand is what metrics we need to use to allow us to assess value to patients and purchasers to enable us to understand what treatment that delivers value, to support innovative treatments by proving their worth and removing those services that deliver no impact.”
Machine learning
Taylor, who joined last month from Axa Health where she was head of specialist practitioner relations and head of pathways, added the sector needed to focus on a range of multi-factor data domains.
“This is why we need machine learning to bring all those data points together,” she continued.
“We need to understand clinical outcomes. What is the survival rate, the recurrence rate, what are the adverse events and complication rates and readmission?
“[What is the] patient experience such as symptom relief? Quality of life? Psychological resilience? Fatigue management? Pain management? Satisfaction and empowerment that the patient feels to take control of their cancer?
She added that costs of care, both direct and indirect, needed to be understood, including treatment, diagnostic costs and side effects related to treatment.
Hold providers to account
But Taylor emphasised that providers also needed to be held to account compared to each other.
“We need to understand outcomes versus national benchmarks,” she continued.
“Benchmarking one provider against another so we can start to really understand where that value erosion has taken place.”
And finally, Taylor called on delegates to understand the longitudinal costs of cancer care.
“It’s not just about the ticket that’s applied to chemotherapy or molecular, does that person get back to work or a productive life?“ she continued.
“And then importantly for our corporates, how can they measure that value of every pound spent by looking at absence and return to work.”