Tuesday, December 04, 2007

Escalating costs of cancer drugs.

Sir, for $500 I can give you 11 months to live; or with today's drugs, I can give you 22 months but it will cost $250,000. So says New Scientist in a scary look at the escalating costs of new cancer drugs.

What had occasioned this article is the announcement of a new deal on Velcade in myeloma, which NICE turned down earlier in the year as not cost effective.

After months of negotiations, the NHS will pay over £24,000 for each successful course of the drug for patients who have tried one other therapy but relapsed. Crucially, it will only pay if blood tests indicate that the drug is working.

There is a real problem with the funding of new cancer drugs. In Sweden, high prices mean that a maximum of 1 in 5 people with the colon cancer receive the drugs they need.

Until recently patients in New Zealand and Australia had to pay up to US$70,000 of their own money for a year's treatment with the drug Herceptin. Only an outcry from patients forced the health systems in these countries to pay for the drug. Even then, the New Zealand government chose to fund only a nine-week course, with patients having to make up the difference if their doctors prescribe a full year's treatment. However, despite the pharmaceutical company suggesting that a year's treatment is needed, an independent, though smaller, Finnish trial suggests it might be equally effective to take the drug for just nine weeks, and that by doing so patients may suffer fewer heart problems, one of Herceptin's acknowledged side effects.

Even in America, 1 in 8 cancer patients have defaulted on debt payments due to their treatment costs and have been contacted by a debt collection agency, according to a survey in 2006 by the non-profit Kaiser Family Foundation, even though they have some form of health insurance. For those without insurance, the proportion is far higher. There are also concerns that publicly funded healthcare agencies, including Medicare in the US and the NHS in the UK, are finding it increasingly difficult to afford the expensive drugs that patients now widely demand.

Identifying exactly how much or how little of a drug is needed is an obvious way to cut costs. The result might be to cut into the manufacturers' profits, so they are unlikely to run such trials themselves unless they are made a condition of the drug being approved. “Governments and healthcare providers and professionals should not sit back and relax once a drug is approved,” says one expert. “They need to be more active in conducting post-marketing studies that address questions that are not just in the interests of the pharmaceutical companies.”

Hence the NIH is running a trial of low dose rituximab in CLL using Ron Taylor style doses. We can expect further de-escalating studies.


Anonymous said...

I think it should be noted that, in general, you are a supporter of the UK's National Health Service, and you decry the amount of money Americans spend on themselves for health care.

It should be remembered that it costs over $800 million to steer a drug through the American clinical trials system. Since Americans pay full price for their drugs, we are subsidizing the researchs costs for the rest of the world.

I'd love to see prices go up in Europe, Asia, and elsewhere, so prices would ease a bit here in the United States.

You believe in the free enterprise system, I assume. Then you must realize that the pharmaceutical companies are in business for one thing, and one thing only. That is to make money. It is not a charity, it is not a warm and fuzzy business. It is a cutthroat business like all businesses are.

Make a profit for your shareholders, or die.

I assume you invest money. I don't think you invest money hoping to lose it. You expect a fair return on your investment, as do I.

We should also remember that the gravy train for pharmaceutical companies runs out after 20 years, and the drug is free to go generic.

The expenditures will be worse before they become better. Eventually, curing cancer will be about as complicated as changing the oil in your car.

I won't be around for those days, but it will be absolutely wonderful to see the unemployment office filled with out-of-work oncologists. I mean no disrespect, but it would still be wonderful.

Anonymous said...

Anonymous said: "Since Americans pay full price for their drugs, we are subsidizing the researchs costs for the rest of the world."

Actually, Americans with good health insurance do not pay full price for drugs. Our health insurance companies negotiate discounts with health care providers, and the bigger insurance companies can get bigger discounts. Following is a common scenario for an American with a good job that provides good health insurance. A medical provider or drug company charges $1,000. Our health insurance company negotiated a 50% discount, so if our policy includes a 10% co-pay then we pay $50 and our insurance company pays $450 of the $1,000 charge. Discounts of 50% and up are common for large insurance companies.

So someone with good health insurance typically pays very little out of pocket for those drugs, someone with not so good health insurance pays a lot, and someone with no health insurance may go bankrupt.

Terry Hamblin said...

Actually, I am not a wholehearted supporter of the NHS - I see many things wrong with it and I think that many insurance-based systems do teh job as well or better. Nor do I decry the amount of money Americans spend on themselves - what I dislike about the American system is teh amount of waste in it. If Americans spent that amount of money in a sensible system it really would be the best in teh world.

The research costs for most drugs are paid by Universities who develop the agents. Pharmaceutical companies do spend a lot on testing the drugs, though these are not by any means all American companies - Aventis, Roche, GSK, Astra Zeneca, Bayer and Novartis are all European companies (there are many more) and comprise more than half the industry. However, much as they spend generously on research, they spend much more on marketing.

Your assumptions on what I do with my money are wide of the mark; I certainly believe in free enterprise, but I also believe in charity.

I wish you were right about how easy it is going to be to cure cancer. But they told me the same thing 50 years ago and it just gets harder.

Anonymous said...

Marketing does sell drugs. You probably didn't see the TV ads for Celebrex, but it was heavily advertised and sales took off accordingly. Celebrex wasn't the only COX-2 inhibitor on the market then, there was Vioxx as well. So marketing is one way of increasing your sales.

It's just like selling cars. Ford, Toyota, and Nissan advertise heavily. It's because there is more than one choice.

I don't know if Gleevic is marketed. It probably is in medical journals and at conferences such as ASH. But there certainly is no need to advertise to the CML patient. He knows (or his doctor tells him) this is the gold standard for treating CML. Marketing when there is one drug isn't necessary.

What I meant by 'curing cancer will be easy' isn't FINDING a cure being easy, but treating it once a 'cure' is found. Treating CML is pretty easy. (Obviously some people develop resistance, etc., but I'm just making a point here.) That's what I meant.

To extend the discussion about marketing, Rogaine (minoxidil) is marketed. Now if there was a slam-dunk cure for baldness, there would be a line stretching halfway to Mars when it became available. However, minoxidil doesn't work very well, so they have to market it.

I guess the adage would be, the better your product works, and the less competition you have, the less marketing you need to do.

I must confess I don't know how inefficient the American healthcare system is. Obviously, we'd all benefit if it were more efficient. On the other hand, the Nazis ran a pretty tight ship, but nobody wants to live under a system like that.

It's good to discuss these things, especially when it's going to go away when Hilary is elected.

Anonymous said...

Terry the approval for Herceptin in Australia was not recent.

The Government has accepted a recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC) to list the drug trastuzumab (Herceptin®) on the Pharmaceutical Benefits Scheme (PBS).

From 1 October 2006, Herceptin has become available on the PBS for women who are diagnosed with HER-2 positive breast cancer, established by testing using a HER-2 gene amplification test. Herceptin will be administered concurrently with adjuvant chemotherapy.

Terry Hamblin said...

October 2006 not recent?