Precision Medicine for Cancer Care Costs a Fortune but Could Save Money in the Long Run

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Michael Caligiuri, M.D. Illustration by Alex Fine

Scientists decoded the DNA of the first human genome in 2003 after a 13-year process that cost $2.6 billion. Today, we can "sequence" the genome of a cancerous tumor in a day for $1,500 to $3,000.

Decoding the genome may be affordable, but the cost of understanding what it means to cancer treatment has exploded. Piecing together the elements of the genome that really matter in medicine and matching that learning with carefully designed new biopharmaceuticals and new opportunities for older drugs requires a hefty investment in research.

As technologies have evolved, our view of the economics of life-changing genetic tests have become more nuanced. It is important to show not only how these tests can guide the decisions we make with our patients but also how additional testing can bring value to the health care system. If spending money on testing can wring out needless care elsewhere by ensuring the right patients get the right medication, or better still prevent disease, even high-priced tests can be a bargain. As Mary Lasker, the great advocate behind the successful passing of the National Cancer Act in 1971 by former president Richard Nixon, said: "If you think research is expensive, try disease."

What makes next-generation genetic testing so appealing is that it brings us closer to the holy grail of medicine: getting better care without spending more money. There is no worse outcome—for the patient, for the physician, for the health care system—than the delivery of a drug that provides nothing but side effects and expenses.

Demonstrating that we can reach that holy grail is key to making sure that health insurers cover genetic testing as part of a holistic cancer treatment program. That value is now clear for many tests and with many insurers; I expect that trend to continue as testing costs decrease and as data shows benefits to patients. But cost coverage is not universal. We must continue to demand that our insurance companies pay for impactful testing and treatments.

This advocacy won't bear fruit overnight. Doctors have an obligation to ensure coverage of increasingly critical tests. Our research cannot ignore the larger conversation around value. It is vital that our research demonstrates how a given test affects costs as well as outcomes.

Getting more genetic and treatment data from cancer patients, electronic health records and the evolution of artificial intelligence in precision medicine will enable physicians to better predict who will get cancer, how to prevent it and which treatment will provide the best outcome at the earliest stage. That is a great deal, no matter how you cut it.

Michael Caligiuri, M.D., is president of City of Hope National Medical Center and the Deana and Steve Campbell Physician-in-Chief Distinguished Chair in Honor of Alexandra Levine, M.D.

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Precision Medicine for Cancer Care Costs a Fortune but Could Save Money in the Long Run