There remain for many people questions about Provenge. The most common question I hear is about the financial cost of the treatment for what has been described as “only 4 months of life extension for $93,000, is it worth it?” Well, the answer is a clear yes!
The clinical trial that was used to obtain the FDA approval of Provenge did show a four month life extension, but the trial was structured (as were the original Taxotere trials) to allow cross over usage of the treatment. The trials compared Provenge against placebo. When men in the no treatment arm failed, they were permitted to then go back and have treatment with Provenge. Many men elected this option and had treatment. So, the comparison was actually between men who had initially received provenge against men who had much later (with significantly more disease progression) treatment. Although there is no way to prove it, many of us believe that the life extension would have been MUCH greater had there not been men who crossed over to receive late treatment.
There have been many complaints about the “high cost” of Provenge, but as I have stated before, the cost is actually consistent with other cancer treatments, including the chemotherapy agent Taxotere, used for advanced prostate cancer. It is very difficult to put a true cost on Taxotere because men stay on the drug for different periods of time and need different levels of additional supportive care. Dr. Snuffy Meyers has estimated that the true cost of Taxotere is between $10,000 and $12,000 per month. This estimate includes the cost of the drug, the infusion, the secondary support costs and the costs of the not infrequent hospitalizations that result from Taxotere toxicity.
The median survival time for men taking Taxotere is three years. So, Taxotere at say, $11,000 per month will have a real cost of $396,000 per man assuming that a man remains on treatment until death. Taxotere showed a survival advantage 2 ½ months, or a cost of $158,400 per month of live extension! Trying to be more realistic, we should assume that most men actually do not remain on treatment the entire three years, but instead are on Taxotere for only half their survival time, or 18 months. Then, the Taxotere survival time of 2 ½ months comes at a monthly cost of $77,200.
Comparing the cost of Provenge at $93,000 for a 4 month survival advantage, or a cost of $23,250 per month of life extension, the economics speak for themselves. No, Provenge is not over priced.
Don’t forget, the men in the trial tended to have very advanced disease. Immunological therapy needs time to take hold and work. Most of us believe that the earlier the therapy is given, the longer the survival advantage. Provenge has the potential, as does Taxotere, to provide an even longer survival advantage than demonstrated in their clinical trials, especially if given earlier in the disease progression.
Let’s not forget that Provenge, besides being cheaper than Taxotere, offers the survival advantage without the same level of side effects. Taxotere is very tolerable, Provenge is much more tolerable.
Longer survival, less side effects at a cheaper cost. It sounds pretty good to me.
Joel T Nowak, MA, MSW