The cost of cancer care is rising to unsustainable levels, partly driven by increases in expenditures for newer therapies. In 2016, the direct costs of cancer care in the US was $74billion1 with predictions of doubling in a decade. In Australia, the PBS subsidised over $4.3billion in 2018/19 for antineoplastic and immunomodulating agents.2 Practitioners bemoan the soaring costs of cancer treatment, offering suggestions to assist with financial toxicity.1,3-4 This is especially true with newer, more expensive immunotherapy treatment.
Fixed dosing of immunotherapy has been justified by arguing improved efficiency in compounding, reduced drug wastage, and reduced errors.5 However, is this approach financially sustainable? Personalized rather than fixed-dosing of pembrolizumab for advanced lung cancer has the potential to save $0.825billion annually in the US.6 In a Canadian review of 6 regional cancer centres, personalised dosing of pembrolizumab decreased costs by around $225,000 whereas fixed dosing increased costs by $6million.
Medicines play an important role in sustainability in cancer care. The use of personalised dosing places sustainability ahead of profit.