How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question
Open accessAbstract
The spiraling cost of cancer care, in particular the cost of cancer therapeutics that achieve only marginal benefits, is under increasing scrutiny. Although health-care professionals avoid putting a value on a life, our limited resources require that society address what counts as a benefit, the extent to which cost should factor in deliberations, and who should be involved in these decisions. Professional societies, such as the American Society of Clinical Oncology, government agencies, including the Food and Drug Administration, and insurance companies should be involved. However, no segment of society is better qualified to address these issues than the oncology community. Oncologists must offer clear guidance for the conduct of research, interpretation of results, and prescription of chemotherapies. We review recent drug approvals and clinical trials and comment on their relevance to the issue of the spiraling cost of oncology therapeutics. We suggest some standards that would serve as a starting point for addressing these issues.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
If treatment costs rise by 2% per year, US cancer treatment and care costs could reach US$173 billion, a 39% increase.
“If treatment costs rise by 2% a year, the overall cost of treatment and care – in the US alone – could reach US$173 billion, a 39% increase.”
US cancer treatment and care costs were projected to rise by 23% between 2010 and 2020, from US$128 billion to US$158 billion, based only on demographic change and with fixed incidence, survival and treatment costs.
“The costs of cancer treatment and care in the US alone were projected to rise by 23% between 2010 and 2020, from US$128 to US$158 billion, solely on the basis of demographic change, and with fixed incidence rates, survival probabilities and treatment costs.101”
Overestimating or overstating benefits from new interventions can cause harm, including confounding public policy, undermining research credibility, harming patients, and fueling inappropriate hype.
“Overestimating or overstating the benefits from new intervention can cause harm: it confounds public policy decision making [29], undermines the credibility of oncology research reporting [26,29,30], harms patients who choose to undertake treatments based on exaggerated expectations that may subject them to either risk of adverse effects, inconvenience or substantial personal costs [26,28] and, in”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Paclitaxel–Carboplatin Alone or with Bevacizumab for Non–Small-Cell Lung Cancer
Sandler, A., Gray, R., Perry, M. C., Brahmer, J., Schiller, J. H., Dowlati, A., Lilenbaum, R., & Johnson, D. H. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa061884 · Cited by 5,761 · see citing works
Trastuzumab plus Adjuvant Chemotherapy for Operable HER2-Positive Breast Cancer
Romond, E. H., Perez, E. A., Bryant, J., Suman, V. J., Geyer, C. E., Davidson, N. E., Tan-Chiu, E., Martino, S., Paik, S., Kaufman, P. A., et al. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa052122 · Cited by 5,355 · see citing works
Trastuzumab after Adjuvant Chemotherapy in HER2-Positive Breast Cancer
Piccart-Gebhart, M. J., Procter, M., Leyland-Jones, B., Goldhirsch, A., Untch, M., Smith, I., Gianni, L., Baselga, J., Bell, R., Jackisch, C., et al. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa052306 · Cited by 5,084 · see citing works
Cunningham, D., Humblet, Y., Siena, S., Khayat, D., Bleiberg, H., Santoro, A., Bets, D., Mueser, M., Harstrick, A., Verslype, C., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa033025 · Cited by 5,035 · see citing works
Sorafenib in Advanced Clear-Cell Renal-Cell Carcinoma
Escudier, B. J., Eisen, T. G., Stadler, W. M., Szczylik, C. A., Oudard, S. M., Siebels, M., Négrier, S., Chevreau, C., Solska, E., Desai, A. A., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa060655 · Cited by 4,802 · see citing works
Moore, M. J., Goldstein, D., Hamm, J., Figer, A., Hecht, J. R., Gallinger, S., Au, H. J., Murawa, P., Walde, D., Wolff, R. A., et al. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2006.07.9525 · Cited by 3,848 · see citing works
Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast Cancer
Miller, K. D., Wang, M., Gralow, J. R., Dickler, M. N., Cobleigh, M., Perez, E. A., Shenkier, T. N., Cella, D. F., & Davidson, N. E. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa072113 · Cited by 3,077 · see citing works
Cetuximab for the Treatment of Colorectal Cancer
Jonker, D. J., O'Callaghan, C. J., Karapetis, C. S., Zalcberg, J. R., Tu, D., Au, H.-J., Berry, S. R., Krahn, M., Price, T., Simes, R. J., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa071834 · Cited by 1,904 · see citing works
Saltz, L. B., Meropol, N. J., Loehrer, P. J., Needle, M. N., Kopit, J., & Mayer, R. J. (2004) · Journal of Clinical Oncology · doi:10.1200/jco.2004.10.182 · Cited by 1,694 · see citing works
Bokemeyer, C., Bondarenko, I., Makhson, A. M., Hartmann, J. T., Aparicio, J., de Braud, F., Donea, S., Ludwig, H., Schuch, G., Stroh, C., et al. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2008.20.8397 · Cited by 1,629 · see citing works
Reck, M., von Pawel, J., Zatloukal, P., Ramlau, R., Gorbounova, V. A., Hirsh, V., Leighl, N. B., Mezger, J. M., Archer, V. R., Moore, N., et al. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2007.14.5466 · Cited by 1,500 · see citing works
Pirker, R., Pereira, J. R., Szczęsna, A., von Pawel, J., Krzakowski, M. J., Ramlau, R., Vynnychenko, I. O., Park, K., Yu, C.-T., Ganul, V., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60569-9 · Cited by 1,346 · see citing works
Chemotherapy, Bevacizumab, and Cetuximab in Metastatic Colorectal Cancer
Tol, J., Koopman, M., Cats, A., Rodenburg, C. J., Creemers, G. J., Schrama, J. G., Erdkamp, F., Vos, A. H., van Groeningen, C. J., Sinnige, H. A. M., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0808268 · Cited by 1,330 · see citing works
Allegra, C. J., Jessup, J. M., Somerfield, M. R., Hamilton, S. R., Hammond, E. H., Hayes, D. F., McAllister, P. K., Morton, R. F., & Schilsky, R. L. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2009.21.9170 · Cited by 1,156 · see citing works
Hecht, J. R., Mitchell, E., Chidiac, T., Scroggin, C., Hagenstad, C., Spigel, D., Marshall, J., Cohn, A., McCollum, D., Stella, P., et al. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.19.8135 · Cited by 850 · see citing works
Escudier, B. J., Szczylik, C. A., Hutson, T. E., Demkow, T., Staehler, M. D., Rolland, F., Négrier, S., Laferriere, N., Scheuring, U. J., Cella, D. F., et al. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.19.3342 · Cited by 489 · see citing works
Cutsem, E. V., Nowacki, M. P., Láng, I., Cascinu, S., Shchepotin, I. B., Maurel, J., Rougier, P. R., Cunningham, D., Nippgen, J., & Köhne, C.-H. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2007.25.18_suppl.4000 · Cited by 313 · see citing works
An Empiric Estimate of the Value of Life: Updating the Renal Dialysis Cost-Effectiveness Standard
Lee, C. P., Chertow, G. M., & Zenios, S. A. (2008) · Value in Health · doi:10.1111/j.1524-4733.2008.00401.x · Cited by 196 · see citing works
Bokemeyer, C., Bondarenko, I., Makhson, A. N., Hartmann, J. T., Aparicio, J., Zampino, M. G., Donea, S., Ludwig, H., Zubel, A., & Koralewski, P. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2007.25.18_suppl.4035 · Cited by 101 · see citing works
The $64,000 question—What is a quality-adjusted life-year worth?
Rascati, K. L. (2006) · Clinical Therapeutics · doi:10.1016/j.clinthera.2006.07.002 · Cited by 29 · see citing works
Is it cost-effective to add erlotinib to gemcitabine in advanced pancreatic cancer?
Grubbs, S. S., Grusenmeyer, P. A., Petrelli, N. J., et al. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2006.24.18_suppl.6048 · Cited by 19 · see citing works
Adams, R., Meade, A. M., Wasan, H. S., Griffiths, G. O., & Maughan, T. (2008) · Expert Review of Anticancer Therapy · doi:10.1586/14737140.8.8.1237 · Cited by 12 · see citing works
DALYs And QALYs In Developing Countries
Zárate, V. (2007) · Health Affairs · doi:10.1377/hlthaff.26.4.1197-a · Cited by 9 · see citing works
Bukowski, R. M., Heng, D. Y. C., Eisen, T., et al. (2008) · European Urology Supplements · doi:10.1016/s1569-9056(08)60693-4 · Cited by 6 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- ASCO Press Briefi ng Sunday , June 1, 9:00 AM (CDT). http://www.asco. org/ASCO/News/Press+Center/Annual+Meeting/News+Releases/Advan ces+in+Lung%2C+Testicular+Cancer .
- Saltz L , Rubin MS , Hochster HS , et al . Cetuximab (IMC-C225) plus iri- notecan (CPT-11) is active in CPT-11 refractory colorectal cancer that expresses epidermal growth factor receptor . Proc Am Soc Clin Oncol . 2001 ; 20 : 3a . Abstract 7 .
- N Engl J Med. 2007 ; 356 ( 2 ): 125 -134 .
Cited by
Sorted by citations
Allemani, C., Matsuda, T., Di Carlo, V., Harewood, R., Matz, M., Nikšić, M., Bonaventure, A., Valkov, M., Johnson, C. J., Estève, J., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)33326-3 · Cited by 6,145 · see citing works
Cherny, N. I., Sullivan, R., Dafni, U., Kerst, J. M., Sobrero, A., Zielinski, C., de Vries, E. G. E., & Piccart, M. J. (2015) · Annals of Oncology · doi:10.1093/annonc/mdv249 · Cited by 818 · see citing works
Delivering affordable cancer care in high-income countries
Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N. J., Amir, E., Khayat, D., Boyle, P., Autier, P., Tannock, I. F., et al. (2011) · The Lancet Oncology · doi:10.1016/s1470-2045(11)70141-3 · Cited by 718 · see citing works
Self-citationWhen are ‘positive’ clinical trials in oncology truly positive?
Ocana, A., & Tannock, I. F. (2011) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djq463 · Cited by 110 · see citing works
Lange, A., Prenzler, A., Frank, M., Golpon, H., Welte, T., & von der Schulenburg, J.-M. (2014) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-14-192 · Cited by 38 · see citing works
- Authors
- Fojo, T., & Grady, C.
- Affiliations
- National Institutes of Health (US)
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06-29
- Volume
- 101
- Issue
- 15
- Pages
- 1044-1048
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC2724853
- OpenAlex
- W2135630936
- Cited by
- 349
- References
- 24
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 13 · 2019: 9 · 2018: 12 · 2017: 22 · 2016: 22 · 2015: 23 · 2014: 44 · 2013: 38 · 2012: 47
- FWCI
- 110.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- cetuximab, non-small cell lung cancer, drug costs, value of life, cost-effectiveness, cancer therapeutics, drug approval, clinical trials, oncology prescribing, healthcare resource allocation
- MeSH terms
- Cetuximab, Antibodies, Monoclonal, Antineoplastic Agents, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung, Cost-Benefit Analysis, Drug Industry, Humans, Lung Neoplasms, Neoplasms, Public Opinion, United States, United States Food and Drug Administration, Survival Analysis, Drug Costs, Treatment Outcome, Drug Approval, Clinical Trials, Phase III as Topic, Disease-Free Survival, Quality-Adjusted Life Years, Value of Life, Antibodies, Monoclonal, Humanized, ErbB Receptors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
