OBJECTIVES : Oncology drug prices are notoriously high in the US compared to Europe, where rigorous HTA assessments usually lead to value-based pricing and sometimes limited access to certain innovations. By contrast, prices of oncology drugs in the US appear to be largely unchecked by payers, who tend to allow open access to drugs, although at rising costs for patients.

This trend is undoubtedly incentivising policy makers to find ways to control oncology spending in the US. This research explores if, by shifting financial responsibility to healthcare providers, US payers are forcing them to become more price sensitive and hence willing to adopt HTA-like tools to drive value-based prescribing decisions.

METHODS : A mobile survey was sent to 120 oncologists in the US with representatives from large academic centres, regional hospitals, hospital affiliated clinics, and private practice. The survey included questions about the extent to which US oncologists feel financial pressure and how this influences decision-making.

RESULTS : Oncologists at large academic centres indicate that it has become more difficult for them to prescribe their first-choice treatments, compared to five years ago. Oncologists at large academic centres are more likely to discuss drug cost with patients and their patients are more likely to discuss financial concerns. Furthermore, oncologists at large academic centres are more likely to have concerns about the impact of drug cost on their hospital budget and are more likely to discuss cost of care with hospital leadership.

CONCLUSIONS : There appears to be a trend toward US oncologists becoming more aware of drug cost, especially at large academic centres. Although the US is unlikely to move toward a more regimented HTA system as seen in many European markets, as oncologists face increased financial pressure, they may be forced to consider cost effectiveness more than they have in the past.