How much money is a drug worth and how much money should we be willing to spend for it have been questions that have been increasingly asked by economists, doctors and cancer survivors.

Last month in an Op-Ed article three doctors from Memorial Sloane Kettering Cancer Center in New York (Sloane) let the world know that Sloane had made a decision not to use a drug made by Sanofi to treat colon cancer. The FDA recently approved the drug, Zaltrap because it extended life by a median of 1.4 months, but at a cost of more than $100,000 per year. Sloane’s decision not to use the drug was simply based on the high cost of the drug, especially given that a competing drug with a similar action, Avastin at one half the cost of Zaltrap has demonstrated a similar median survival advantage in similar patients.

As a result of this announcement Sanofi has stated that they will now provide Zaltrap to the America market at a 50% discount (this means that the base price of the drug to the medical community will remain the same for the purpose of insurance reimbursements). This action could provide an additional economic incentive for doctors to make the clinical decision to use Zaltrap over Avastin solely for their own economic gain.

Sloane has stated that they will not change their decision and will continue not to use Zaltrap. I believe that Sloane’s decision to not move in the direction of their own economic gain is laudable.

This is probably the first time that doctors have stood up to the pharmaceuticals and objected to the high prices of certain cancer drugs. This is probably the first time that doctors have asked about the relationship of the cost of cancer drugs, its development costs and the ultimate value it provides to the cancer survivor.

In the prostate cancer world there has also been economic push back to the increasingly high costs of drugs for men with advanced prostate cancer. Zytiga costs about $5,000/month; Jevtana about $8,000 every three weeks; Provenge $93,000 for the entire course of treatment; Xtandi about $6,500/month and we don’t yet know what the cost of Alpharadin if approved but experts have said that it will probably be in excess of $25,000.

Do any of these costs actually bear a relationship to the real development and manufacturing cost burdens of the pharmaceuticals? I know that I can not answer this question, but it is not surprising that these questions are now being asked and it is good that they are now being asked.

Even in the cost of primary prostate cancer treatments the costs have grown astronomically and without any rational reason. A review of Medicare records showed that the average reimbursement for proton beam therapy is about $32,500 while the reimbursement for IMRT is only $18,500, a significant cost difference without any evidence of any clinical advantage for proton beam treatment.

So, where is this going to end? Could this mini-revolution at Sloane be the needed warning shot over the bow of the pharmaceuticals, or is it just going to be business as usual?

Joel T. Nowak, M.A., M.S.W.