Prescribing High-Priced Cancer Drugs: Rethinking Physicians’ Choice Regarding Expensive Treatments

Abstract

As the prices of cancer treatments are constantly rising, reaching tens and hundreds of thousands of euros per patient, this article examines the existence and impact of these prices in everyday hospital practice and in relation to medical autonomy. Our study takes place in the French health care system, which is characterized by the coverage of health care costs by the health insurance system. Through ethnographic observations carried out in hematology and thoracic oncology departments, the study explores how prices, although invisible and excluded from medical practice, can come into play in situations of tension at the boundaries of medical, administrative and financial prescriptive frameworks. However, this paper shows how the innovative and complex nature of these costly treatments can be reinterpreted in terms of value and even become a source of credit.

Keywords

oncology cancer drugs prices medical practices medical autonomy hospitals ethnographic studies

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References

Abbott

(1988). The system of professions: An essay on the division of expert labor. University of Chicago Press.

Abecassis

Coutinet

(2017). Politique d’austérité et politique du médicament en France et au Royaume-Uni : une analyse de leurs répercussions sur le modèle de production pharmaceutique [Austerity policy and drug policy in France and the United Kingdom: An analysis of their impact on the pharmaceutical production model]. La Revue de l’Ires, 1(91–92), 111–140. https://doi.org/10.3917/rdli.091.0111

Aggarwal

Fojo

Chamberlain

Davis

Sullivan

(2017). Do patient access schemes for high-cost cancer drugs deliver value to society? Lessons from the NHS Cancer Drugs Fund. Annals of Oncology, 28(8), 1738–1750. https://doi.org/10.1093/annonc/mdx110

Altomonte

(2020). Exploiting ambiguity: A moral polysemy approach to variation in economic practices. American Sociological Review, 85(1), 76–105. https://doi.org/10.1177/0003122419895986

Aron

Geeraert

Izambert

(2021). L’accueil des patients étrangers à l’hôpital sous le feu croisé des réformes comptables et des politiques d’immigration [The admission of foreign patients in hospitals under the crossfire of accounting reforms and immigration policies]. Revue Française des Affaires Sociales, 4(4), 77–96. https://doi.org/10.3917/rfas.214.0077

Assurance Maladie . (2017). Améliorer la qualité du système de santé et maîtriser les dépenses : les propositions de l’Assurance Maladie pour 2018 [Improving the quality of the healthcare system and controlling expenditure: The French assurance maladie's proposals for 2018. Assurance maladie’s annual proposal reports.]. Rapports annuels de propositions de l’Assurance Maladie.

Aust

Castel

Vézian

(2019). Structurer la recherche française en cancérologie. Heurs et malheurs d’un projet réformateur [Structuring cancer research in France: Triumphs and challenges of a reformative project]. Presses de l’EHESP.

Balcom

Doucet

Dubé

(2021). Observation and institutional ethnography: Helping us to see better. Qualitative Health Research, 31(8), 1534–1541. https://doi.org/10.1177/10497323211015966

Becker

H. S.

(1998). Tricks of the trade. How to think about your research while you’re doing it. The University of Chicago Press.

10.

Berg

Horstman

Plass

Van Heusden

(2000). Guidelines, professionals and the production of objectivity: Standardisation and the professionalism of insurance medicine. Sociology of Health & Illness, 22(6), 765–791. https://doi.org/10.1111/1467-9566.00230

11.

Bernal

Iráizoz

(2018). Cancer drugs: High prices and inequity. No es Sano Campain.

12.

Bigot

Negellen

Breton

Ifrah

Dahan

Hoog-Labouret

Bihan

C. L.

Ropers

(2017). Le prix des médicaments anticancéreux. Etat des lieux et des connaissances / Soins [The price of anti-cancer drugs: Current status and knowledge / care, National Cancer Institute.]. Institut National du Cancer.

13.

Birch

Muniesa

(Eds.). (2020). Assetization: Turning things into assets in technoscientific capitalism. The MIT Press.

14.

Borup

Brown

Konrad

Van Lente

(2006). The sociology of expectations in science and technology. Technology Analysis & Strategic Management, 18(3–4), 285–298. https://doi.org/10.1080/09537320600777002

15.

Brigand

Maguet

Veras

Durish

(2020). Plaidoyer pour l’accès équitable aux nouvelles technologies de santé : le cas du Kymriah® [Advocacy for Equitable Access to New Health Technologies: The Case of Kymriah®]. Santé Publique, 5(32), 525–529. https://doi.org/10.3917/spub.205.0525

16.

Brown

(2003). Hope against hype - Accountability in biopasts, presents and futures. Science and Technology Studies, 16(2), 3–21. https://doi.org/10.23987/sts.55152

17.

Cassier

(2023). Il y a des alternatives: une autre histoire des médicaments (XIXe-XXIe siècle) [There are alternatives: A different history of medicines (19th-21st Century)]. Seuil.

18.

Cassier

Gaudillière

J.-P.

(2000). Recherche, médecine et marché: la génétique du cancer du sein [Research, medicine, and the market: The genetics of breast cancer]. Sciences Sociales et Santé, 18(4), 29–51. https://doi.org/10.3406/sosan.2000.1504

19.

Castel

(2008). La gestion de l’incertitude médicale : approche collective et contrôle latéral en cancérologie [Managing medical uncertainty: Collective approach and lateral control in oncology]. Sciences Sociales et Santé, 26(1), 9–32. https://doi.org/10.3917/sss.261.0009

20.

Chabrol

David

P.-M.

Krikorian

(2017). Rationing hepatitis C treatment in the context of austerity policies in France and Cameroon: A transnational perspective on the pharmaceuticalization of healthcare systems. Social Science & Medicine, 187(1982), 243–250. https://doi.org/10.1016/j.socscimed.2017.03.059

21.

Cour des comptes . (2024). Chapitre 4 – Les medicaments anticancéreux: mieux regular en préservant un accès rapide aux traitements innovants [Anti-cancer drugs: Better regulation while preserving quick access to innovative treatments. annual report on social security]. Rapport annuel sur la Sécurité sociale.

22.

Dew

Stubbe

Signal

Stairmand

Dennett

Koea

Simpson

Sarfati

Cunningham

Batten

Ellison-Loschmann

Barton

Holdaway

(2015). Cancer care decision making in multidisciplinary meetings. Qualitative Health Research, 25(3), 397–407. https://doi.org/10.1177/1049732314553010

23.

Eckouse

Lewison

Sullivan

(2008). Trends in the global funding and activity of cancer research. Molecular Oncology, 2(1), 20–32. https://doi.org/10.1016/j.molonc.2008.03.007

24.

Elias

(1981). Qu’est-ce que la sociologie? [What is Sociology?] Pocket.

25.

Fleck

L. M.

(2022). Precision medicine and the fragmentation of solidarity (and justice). Medicine, Healthcare & Philosophy, 25(2), 191–206. https://doi.org/10.1007/s11019-022-10067-2

26.

Flore

Kokanović

Broom

Heynemann

Lai-Kwon

Jefford

(2023). Entanglements and imagined futures: The subject(s) of precision in oncology. Social Science & Medicine, 317(2), Article 115608. https://doi.org/10.1016/j.socscimed.2022.115608

27.

Freidson

(1988). Profession of medicine: A study of the sociology of applied knowledge. University of Chicago Press.

28.

Graham

C. S.

Swan

(2015). A path to eradication of hepatitis C in low- and middle-income countries. Antiviral Research, 119, 89–96. https://doi.org/10.1016/j.antiviral.2015.01.004

29.

Gray

T. F.

Allgood

S. J.

Nolan

M. T.

Gallo

J. J.

Han

H. R.

Clayman

M. L.

Budhathoki

Lansey

D. G.

Wenzel

(2022). “It all depends”: Patient and decision partner experiences in cancer clinical trial decision-making. Qualitative Health Research, 32(6), 887–901. https://doi.org/10.1177/10497323221083355

30.

Gyawali

Sullivan

(2017). Economics of cancer medicines: For whose benefit? The New Bioethics, 23(1), 95–104. https://doi.org/10.1080/20502877.2017.1314885

31.

Hassenteufel

(1997). Les médecins face à l’État: une comparaison européenne [Doctors and the state: A European comparison]. Presses de Sciences po.

32.

Hedgecoe

(2004). The politics of personalised medicine: Pharmacogenetics in the clinic. Cambridge University Press.

33.

Hillersdal

Svendsen

(2022). Cancer currencies: Making and marketing resources in a first-in-human drug trial in Denmark. In Bremer

Strand

(Eds.), Precision oncology and cancer biomarkers. Issues at stake and matters of concern (pp. 45–60). Springer.

34.

Iriart

J. A. B.

Gibbon

(2023). Biomedical innovations, cancer care and health inequities: Stratified patienthood in Brazil. In Bennett

L. R.

Manderson

Spagnoletti

(Eds.), Cancer and the politics of care: Inequalities and interventions in global perspective (pp. 23–41). UCL Press.

35.

Jasanoff

Kim

S.-H.

(Eds.). (2015). Dreamscapes of modernity: Sociotechnical imaginaries and the fabrication of power. The University of Chicago Press.

36.

Joly

P.-B.

(2015). Le régime des promesses technoscientifique. In Audétat

(Ed.), Pourquoi tant de promesses (pp. 31–48). Hermann.

37.

Juven

P.-A.

(2016). Une santé [The Regime of Technoscientific Promises] In Audétat

Why So Many Promises, (Ed.) qui compte ? Les coûts et les tarifs controversés de l’hôpital public [ Health that counts? Controversial public hospital costs and charges]. Presses Universitaires de France.

38.

Juven

P.-A.

(2019). La valeur des médicaments. Calculs et controverses [The Value of Medicines: Calculations and Controversies]. In Castel

Juven

P. A.

Vézian

, (Eds.), Les politiques de lutte contre le cancer en France. Quels regards sociologiques sur la régulation des pratiques médicales et des innovations? [Cancer Control Policies in France] (pp. 179–198) Presses de l’EHESP.

39.

Juven

P.-A.

Pierre

Vincent

(2019). La casse du siècle. À propos des réformes de l’hôpital public [The heist of the century: public hospital reforms.]. Raisons d’agir.

40.

Kerr

Chekar

C. K.

Ross

Swallow

Cunningham-Burley

(2021). Personalised cancer medicine: Future crafting in the genomic era. Manchester University Press.

41.

Kesselheim

A. S.

Avorn

Sarpatwari

(2016). The high cost of prescription drugs in the United States: Origins and prospects for reform. JAMA, 316(8), 858–871. https://doi.org/10.1001/jama.2016.11237

42.

Kityo

Cortes

C. P.

Phanuphak

Grinsztejn

Venter

(2022). Barriers to uptake of long-acting antiretroviral products for treatment and prevention of HIV in low- and middle-income countries (LMICs). Clinical Infectious Diseases, 75(Suppl 4), S549–S556. https://doi.org/10.1093/cid/ciac752

43.

Kohli-Laven

Bourret

Keating

Cambrosio

(2011). Cancer clinical trials in the era of genomic signatures: Biomedical innovation, clinical utility, and regulatory-scientific hybrids. Social Studies of Science, 41(4), 487–513. https://doi.org/10.1177/0306312711398741

44.

Lakoff

(2006). Pharmaceutical reason: Knowledge and value in global psychiatry. Cambridge University Press.

45.

Light

(1991). Professionalism as a countervailing power. Journal of Health Politics, Policy and Law, 16(3), 499–506. https://doi.org/10.1215/03616878-16-3-499

46.

Light

(2000). The medical profession and organizational change: From professional dominance to countervailing power. In Handbook of medical sociology, Vanderbilt University Press (pp. 201–2019). Prentice Hall.

47.

Livingston

(2012). Improvising medicine: An African oncology ward in an emerging cancer epidemic. Duke University Press.

48.

Maraninchi

Vernant

J.-P.

(2016, March 14). L’urgence de maîtriser les prix des nouveaux médicaments contre le cancer [The urgent need to control the price of new cancer drugs]. Le Figaro.

49.

McReynolds

C. J.

Koch

L. C.

Rumrill

P. D.

(2001). Qualitative research strategies in rehabilitation. Work, 16(1), 57–65. https://doi.org/10.3233/WOR-2001-00125

50.

Miljković

M. D.

Tuia

J. E.

Olivier

Haslam

Prasad

(2022). Association between US drug price and measures of efficacy for oncology drugs approved by the US Food and Drug Administration from 2015 to 2020. JAMA Internal Medicine, 182(12), 1319–1320. https://doi.org/10.1001/jamainternmed.2022.4924

51.

Mukherjee

(2010). The emperor of all maladies: A biography of cancer. Scribner.

52.

Nelson

N. C.

Keating

Cambrosio

(2013). On being “actionable”: Clinical sequencing and the emerging contours of a regime of genomic medicine in oncology. New Genetics & Society, 32(4), 405–428. https://doi.org/10.1080/14636778.2013.852010

53.

Nouguez

É.

(2016). Gouverner la concurrence par les prix [Governing the competition through prices]. In Dubuisson-Quellier

(Ed.), Gouverner les conduites [Governing conducts] (pp. 229–262). Presses de Sciences Po.

54.

Nouguez

É.

(2017). Des médicaments à tout prix [Drugs at all costs]. Presses de Sciences Po.

55.

Nouguez

É.

Benoît

(2017). Gouverner (par) les prix. La fixation des prix des médicaments remboursés en France [Governing (through) prices. Setting prices for reimbursed drugs in France]. Revue Française de Sociologie, 58(3), 399–424. https://doi.org/10.3917/rfs.583.0399

56.

Novas

(2006). The political economy of hope: Patients’ organizations, science and biovalue. BioSocieties, 1(3), 289–305. https://doi.org/10.1017/s1745855206003024

57.

Pinell

(1992). Naissance d’un fléau [Birth of a Plague]. Editions métailié.

58.

Ravelli

(2015). La stratégie de la bactérie: une enquête au coeur de l’industrie pharmaceutique [The strategy of the bacteria: an investigation into the heart of the pharmaceutical industry]. Seuil.

59.

Rodwin

M. A.

Mancini

Duran

Jalbert

A.-C.

Viens

Maraninchi

Gonçalves

Marino

(2021). The use of ‘added benefit’ to determine the price of new anti-cancer drugs in France, 2004–2017. European Journal of Cancer, 145(1), 11–18. https://doi.org/10.1016/j.ejca.2020.11.031

60.

Røe

O. D.

(2017). The high cost of new cancer therapies—A challenge of inequality for all countries. JAMA Oncology, 3(9), 1169–1170. https://doi.org/10.1001/jamaoncol.2016.6335

61.

Rolland

Sicot

(2012). Les recommandations de bonne pratique en santé. Du savoir médical au pouvoir néo-managérial [Good practice recommendations in healthcare. From medical knowledge to neo-managerial power]. Gouvernement et action publique [Government and public action], 1(3), 53–75. https://doi.org/10.3917/gap.123.0053

62.

Roy

(2020). A crisis for cures? Tracing assetization and value in biomedical innovation. In Birch

Muniesa

(Eds.), Assetization: Turning things into assets in technoscientific capitalism (pp. 97–124). The MIT Press.

63.

Schleidgen

Klingler

Bertram

Rogowski

W. H.

Marckmann

(2013). What is personalized medicine: Sharpening a vague term based on a systematic literature review. BMC Medical Ethics, 14(1), Article 55. https://doi.org/10.1186/1472-6939-14-55

64.

Secrétariat général de la commission des comptes de la sécurité sociale, Direction de la Sécurité sociale, Mission comptable permanente, & ACOSS . (2023). Les Comptes de la Sécurité Sociale.

65.

Starr

(2017) The social transformation of american medicine: The rise of a sivereign profession & the making of a vast industry: With a new epiloque by the author (Updated edition). Basic Books.

66.

Strauss

Shizuko

Suczek

Wiener

(1985). Social organization of medical work. University of Chicago Press.

67.

Timmermann

(2014). Introduction: The history of a recalcitrant disease. In Timmermann

(Ed.), A history of lung cancer: The recalcitrant disease (pp. 1–10). Palgrave Macmillan UK.

68.

Timmermans

Berg

(2003). The gold standard: The challenge of evidence-based medicine and standardization in health care. Temple University Press.

69.

Tranvåg

E. J.

Strand

(2022). Rationing of personalised cancer drugs: Rethinking the co-production of evidence and priority setting practices. In Bremer

Strand

(Eds.), Precision oncology and cancer biomarkers: Issues at stake and matters of concern (pp. 235–250). Springer International Publishing.

70.

Tutton

(2014). Genomics and the reimagining of personalized medicine. Routledge & CRC Press.

71.

Wadmann

Hauge

A. M.

(2021). Strategies of stratification: Regulating market access in the era of personalized medicine. Social Studies of Science, 51(4), 628–653. https://doi.org/10.1177/03063127211005539

72.

Wadmann

Hauge

A. M.

Emdal Navne

(2023). Good conduct in a context of rationing: A case study of how frontline professionals deal with distributive dilemmas of novel gene therapies. Sociology of Health & Illness, 45(3), 684–704. https://doi.org/10.1111/1467-9566.13608

73.

World Health Organization . (2018). Technical report: Pricing of cancer medicines and its impacts: A comprehensive technical report for the World Health Assembly.

74.

Zussman

(1997). Sociological perspectives on medical ethics and decision-making. Annual Review of Sociology, 23(1), 171–190. https://doi.org/10.1146/annurev.soc.23.1.171