Cost Only

This type of study ignores clinical outcomes and relies exclusively upon the expense of a treatment or strategy. Many newer and more expensive agents improve quality and quantity of life (cetuximab, bevicizimab, irinotecan, or oxaliplatin in metastatic colon cancer; all at $2,000-$4,000 per treatment).6 This type of method is often used by insurers as a rationale to not cover particular medications that may be efficacious but do not have enough supporting data to become a requisite standard of care. Ibritumomab tiuxetan (zevalin), an yttrium-90 antibody to CD20, is an active agent against non-Hodgkins lymphoma (NHL), but may register acute "sticker-shock" effect with many payers at $22,000-$28,000 per dose. And although it appears to have definite activity in NHL, it has not yet evolved into a definitive treatment choice in the algorithm of salvage therapy, at least in part because payers may not reimburse for its use. Unfortunately, cost alone does not help clinicians choose among a variety of therapeutic strategies, unless out-of-pocket expenses for patients make treatment unattainable.

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