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
Joel, as always, well said!
Having had Taxotere immediately after my conventional RP and having 3 spent days in the hospital immediately after the first treatment (colitis), the numbers really make sense.
I will also say that I believe that my current state of reasonable health 2.5 years later (T3CN0 MX–G9 at diagnosis)may well be due to aggressive use of Taxotere by my onc here in Texas followed by Lupron rather than holding Taxotere until I became refractive.
I have just statrted my first Lupron off cycle. PSA currently <0.05.
I agree with this analysis. I had Taxotere for 5 months last year. Results were spectacular (reduced PSA from 99 to 0.5), but I was sick as a dog by the end, and also had three hospital visits (2x 2-day, 1 4-day) because of neutropenic fevers. So it was a very spendy treatment, though it was effective for awhile.
After I came off Taxotere in August 2009(it stopped working) my PSA roared back from 0.5 to 100 in four months.
So I did Provenge from Dec-January. Since late January my PSA has stabilized at 130 (unchanged now for 3.5 months), and I’ve had no known side effects from Provenge. I pray that Provenge will continue its work cause I’m enjoying stable health with hardly any side effects from it.
Oh good, at $93,000 Provenge is cheaper than Taxotere, but I haven’t got $93,000, or even the $18,000 for the co-pay. Guess I’ll just die.
Dendreon has set up a system to help cover co-pays. Call the contact center and see what they ight be able to do for you.
I simply hate the idea that I have to pay for my life with the money I was saving all my life!
Thanks Joel, I will. On a magistrate’s salary I’m bound to be eligible for at least some assistance.
Call the Dendreon call center and see if you qualify for assistance with your co-pay (assuming you have insurance).