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.