{"doi":"10.1111/bju.16092","title":"Drug costs: acquisition costs are critical but not the entire story of financial toxicity","abstract":"Benjamin et al. used acquisition and pricing data to determine treatment costs for newly approved second- and third-line agents for metastatic urothelial carcinoma (mUC) [1]. They found that patients who underwent the median duration of treatment for each therapy based on Phase II and III clinical trials were subject to the following acquisition costs/prices: enfortumab vedotin, $158,477; erdafitinib, $136,080; and sacituzumab govitecan, $90,023. Although the comparative effectiveness amongst many new cancer treatments is often unknown, the cost implications to patients, insurers, and society can be drastically different based on drug choice and clinician decision making. In this study, the acquisition costs for various second- and third-line treatment options for mUC treatment are different. The concept of differing costs across various treatment alternatives also applies to other genitourinary malignancies, such as metastatic castrate-resistant prostate cancer [2]. These price differences suggest that clinician decision making leads to varying cost implications for patients, insurers and society, and could contribute to differences in patient financial burden. When considering these data, however, it is important to keep in mind that acquisition costs and drug prices are often different from what insurers pay for a drug on a beneficiary's behalf (and therefore what is likely indirectly passed down to patients through higher premiums); gross payments made by insurers are frequently concealed through complex pricing mechanisms [3]. In addition, patient out-of-pocket payments are not necessarily proportional to insurer payments [2]. Financial toxicity, a term first described in 2013, illustrates the subjective and objective burden attributable to the high costs of medical care. Large out-of-pocket payments for cancer care can have numerous and devastating consequences for patients, including psychological stress, medication non-adherence leading to differing outcomes, lower spending on food and other essential services, reduced quality of life and decreased survival [4]. Assessing and communicating about patient drug payments are two components of addressing financial toxicity. Drug payments alone, however, underestimate total treatment costs as these estimates do not include additional payments often required for drug administration, such as infusion centre fees, clinic visits and laboratory tests to monitor treatment. Furthermore, these payments do not capture indirect costs of treatment such as time off from work for the patient and/or the patient's family member, childcare, parking, and travel. Importantly, assessment of payments alone does not capture the subjective burden of the high costs of cancer care. Prescribing decisions for advanced urological cancers can vary based on clinician specialty and location and patient race and income [5, 6]. Prior work demonstrates that clinician decision making can drive significant variation in healthcare payments. To reduce financial toxicity and improve health outcomes, a better understanding of out-of-pocket payments across populations and individual-specific estimates, including health plan information, is critical. However, while costs and out-of-pocket payments may be important to some patients, other factors such as survival, side effect profiles, routes of administration and dosing schedules may be equally or more important to others. To better align patient values with clinician recommendations, it is critical for a clinician to assess and understand an individual's values. By better understanding and addressing patients' values, including financial concerns, we have the opportunity to reduce the financial toxicity of cancer care and improve health outcomes. This work was supported in part by the National Cancer Institute of the National Institutes of Health (NIH; 1-K08CA267062-01A1). The content is solely the responsibility of the author and does not necessarily represent th","journal":"British Journal of Urology","year":2023,"id":374926,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9383,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":576281,"name":"Deborah R. Kaye","orcid":"0000-0002-3868-6920","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T01:16:15.380731Z","pmid":"37302985","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}