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.
I repeat the message I posted on the Malecare website a few months ago. I know that not everyone – and indeed perhaps no-one else – will share my view but I believe that we all need to stand back occasionally and look at the wider picture even if painful decisions have to be made. My resolve is unchanged.
“I am in Australia where not all of these drugs/treatments can be obtained but even if they were I have decided that given their staggeringly high cost and, in my opinion, the lamentably low average survival benefit claimed for them, they are not an option for me. After nine years IHT goserelin/bicalutamide and then failure of nilutamide, I have just started keto/cortisone which I think I will make my last treatment aimed at increased survival. That said, I still intend to do what I can to maintain QOL.
Whether paid for by state health schemes, insurance companies or by the individual himself, the costs are unsustainable and don’t appear to be coming down anytime soon. Largely falling into the latter payment category, my decision is to leave whatever I have to my wife and not the medical industry. In the September edition of ‘Choices’ (http://paactusa.org) an indication of the some of the treatment costs and overall survival benefits is shown as –
Taxotere $24120 (2.4 mths)
Jevtana $48000 (2.4 mths)
Provenge $93000 (4.1 mths)
Zytiga $40000 (4.6 mths)
to which can be added
Xtandi $60000 (unknown)
Not worth it as far as I’m concerned. I’m not being negative and maybe I’ll change my views in the future, especially if I win some lottery or other.”
Each of us need to make the decisions that are most consistent with our own beliefs. Your argument is valid and worthy consideration by all of us. When we make these types of decisions we do need to remember that the survival numbers are all medians, so one-half minus one will have an added survival benefit over the median numbers. If we do decide to expend the resourse we alll need to pray that we are in at least the last quarter of the curve, perhaps being in the statistical tail. – Joel