Could QALYs help in assessing high-priced cancer treatments?

For doctors at Memorial Sloan-Kettering Cancer Center in late 2012, it was an easy call. The drug Zaltrap, new on the market (Bach 2012) for treatment of patients with metastatic colorectal cancer, promised to provide an overall survival benefit of 1.4 months compared with a standard chemotherapy regimen. But so did Avastin (bevacizumab) — and the two drugs had similar mechanisms of action, preventing the interaction of VEGF with its receptors. The chief difference was that Zaltrap, initially priced at $11,000 for one month of treatment, cost more than twice as much as Avastin. So the oncologists decided not to use this costly drug. And from the perspective of the cancer center, the story has a happy ending: The marketers of Zaltrap began offering the drug to hospitals at a 50% discount. But other comparisons of oncology products are not so straightforward. A new drug may offer a modest improvement in overall survival quality of life in the absence of a survival benefit. What then? Outside the United States, policymakers turn to a measurement unit called the “quality-adjusted lifeyear,” (see “What’s a QALY?” on page 33), though with less enthusiasm than in years past to inform decisions on allocating resources to new drugs. And some experts think it may be time for QALY’s American debut. Could QALYs Help in Assessing High-Priced Cancer Treatments?