STEVE INSKEEP, HOST:
Now we have the story of information you get from your doctor as well as information you do not.
DAVID GREENE, HOST:
A good doctor is a source of information. You can ask what might be causing a bump on your wrist or whether you can take one medication with another one.
INSKEEP: Yet, the doctor often will not know the answer to a really basic question, a question you'd ask in almost any other transaction - how much is your treatment going to cost? David Kestenbaum, of NPR's Planet Money team, reports on one effort to change that.
DAVID KESTENBAUM, BYLINE: Richard Schilsky is a cancer doctor, and cancer drugs can vary a lot in cost. They can range from hundreds of dollars a month to thousands. But like a lot of doctors, that was not something he paid a lot of attention to.
RICHARD SCHILSKY: You know, where I worked in an academic medical center for just about 30 years, I had no idea what the drugs cost. It wasn't my job to know, and frankly, the information was not, you know, readily available.
KESTENBAUM: Schilsky today is the chief medical officer of the American Society of Clinical Oncology, which recently decided it would be good to have a kind of database of cancer drugs. The database would include a score for each drug - basically how well the drug worked - and also right next to it, how much the drug cost. About a month ago, Schilsky's group published a paper laying out the idea, and at the back of the paper, just as kind of an example, it laid out the numbers for a few drugs. Some of those drugs did not come out looking so good. There was this one lung cancer drug in particular made by Eli Lilly.
SCHILSKY: It's called Pemetrexed, or the brand name is Alimta.
KESTENBAUM: Alimta scored a zero, meaning it didn't work any better than the standard treatment. And then there was the cost - 10 times more expensive than the standard treatment.
SCHILSKY: Nine thousand one hundred ninety-three dollars per month.
KESTENBAUM: Bloomberg Business ran a story headlined "Drug Costing $9,200 Score Zero On Cancer Doctor Value Scale." The article noted that the drug, Alimta, was also Eli Lilly's best seller last year, and it brought in a revenue of $2.8 billion. Eli Lilly declined to make anyone available for this story, but Schilsky says Eli Lilly called his team, questioning that score of zero and pointing out that the drug is intended for patients with a particular kind of lung cancer. Schilsky says that was a fair point, so his group put out an additional score for the drug's effectiveness on that subgroup of patients.
SCHILSKY: The net health benefit score was 16.
KESTENBAUM: Better than zero, but it's out of a total possible score of 130.
SCHILSKY: So 16 is certainly at the low end of that range.
KESTENBAUM: On average, it allows patients to live an extra six weeks compared to the cheaper treatment. Is it worth it? That is normally a question pondered by insurance companies. Schilsky says maybe the rest of us should be thinking about it also.
SCHILSKY: This is one of the real difficulties with the U.S. health care system is that the cost of almost any kind of treatment are largely invisible to either the providers of that treatment or the patients who are receiving that treatment.
KESTENBAUM: What should a patient do when there is one drug that is a little better but costs a lot more? That is a hard decision, but he says one worth having. David Kestenbaum, NPR News.
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