What is the real cost of approved treatments for advanced prostate cancer and how much we should spend? These questions are rippling through the prostate cancer community and the general population.
We find ourselves in a time when both the federal and our state governments are struggling to pay for the costs of basic services. Massive numbers of people are out of work and many are losing their cars and their homes. Our economic future is in serious doubt. How to resolve our economic woes is debated with little consciences among people.
When Dendreon announced the price for the Provenge protocol, $93,000, people were outraged. How could a treatment that only offered a 4 month life extension cost so much? The real question that never really got voiced is: Is four months of additional life in an old man worth that much money?
To respond to these questions I posted on May 19, 2010 an article entitled Provenge, It Isn’t Over Priced, Its Actually A Bargain Basement Product (http://advancedprostatecancer.net/?p=1574). My conclusion was that when compared to the real cost of taxotere (chemotherapy) Provenge was cheap for the life extension it provided.
In June, the FDA approved a new drug, Cabazitaxel (Jevtana) as a second line treatment for men with metastatic prostate cancer who have failed chemotherapy. Jevtana demonstrated an increased survival of 2.5 months. The projected cost for the Jevtana protocol is $48,000, or $19,200 per additional month of survival. This number does not include any allowance for additional medical or hospital costs that I am sure will be required for many men who take Jevtana. These additional costs can become significant since Jevtana comes with many very significant side effects and the men who do qualify for the drug are already very sick and weakened.
Since the average cost for each additional month of survival for Provenge is $23,250, for Taxotere $77,200 per additional month of survival (see: http://advancedprostatecancer.net/?p=1574) and for Jevtana it will significantly exceed $19,200 per month once you include the anticipated additional medical and hospitalization costs, you can see that all these treatments are consistently expensive. I believe that these relative costs are similar to other treatments for other cancers.
Our society must find a way to begin an honest conversation about our future. Are we prepared to spend this level of funds, and if not, will be honest and say that we have put a dollar value on human life?
Joel T Nowak, M.A., M.S.W.
Good point, but we will never have an honest dialogue before we are capable of having “informed” dialogue. We have come a long way since my grandmother gave the GP a couple of chickens to do what he could for my dad’s measles, but I suspect that few of us understand the blend of risk pooling, cost deferring, tax-payer safety netting, private captal fostering morass that is our healthcare system. Unfortunately, without understanding these things this debate will be worse than rhetorical. Consider hust the note above and what is neededed.
First of all, it is essential that we define “we” who will decide the price of two, three or four months additional life, in the above article; 1. everyone in the United States? 2. All citizens of the United States, 3. All Taxpayers in the United States? 4. All voters? 5. Our elected/bought representatives? 6. The medical insurance industry? 7. The health services industry? 8. All PC Patients? Just to frame why this segment of the debate, assume that my $90k Provenge must come at the expense of school lunch programs. I already know that kids are going hungry, especially in the summer and my conscience won’t support taking food away from starving kids so that I can enjoy another three months of the semi-life that Castration Resistant Prostate Cancer will permit me with Provenge! so just between me an the health services industry where you might assume co-interest, that is not necessarily so. Second, we must define, “real cost,” 1. fair market value? 2. cost plus? 3. what the company says it is?
It is a good question, but the starting point will be very hard.