The huge annual conference of the American Society of Oncology began on May 29th in Chicago. While the Conference features the typical fare of scientific presentations to physicians highlighting the most recent medical advances in cancer treatment, this year’s edition is also witnessing the scale-up of a major debate over the cost-effectiveness of cancer drugs. Generally speaking, the US is the established world leader in bank-breaking drugs. But, as a typical course of a cancer pharmaceutical is now topping $200,000 and a couple of new drugs costing almost $300,000 per treatment, insurance companies and cancer doctors are raising red flags over the costs of these treatments. The Conference is set with the backdrop of the United States having just spent over 20% more on cancer drugs in 2014 as it did in 2013 and this follows a 24% year-over-year increase from 2012.
Dr. Leonard Saltz, a gastrointestinal oncologist from Memorial Sloan Kettering Cancer Center called for limits on the cost of cancer therapies. “These drugs cost too much,” said Saltz. Speaking out against the high and increasing prices of cancer drugs is nothing new for Saltz, who co-authored a 2012 op-ed piece in the New York Times. He recently highlighted the cost of a Bristol-Myers-Squibb combination targeting melanoma as being a poster child example of phenomenally high pharmaceutical prices. The combination of Opdivo and Yervoy, costs about $295,000 per year for an average patient according to Saltz. “If all advanced cancer patients in the U.S. received drugs at that price”, he continued, “the total cost would reach $174 billion per year.”
“We need to first accept that there has to be some upper limit as to what we as a society are going to be willing to spend on a patient, and we have to be willing to engage in that discussion,” Saltz said in an interview with Bloomberg at the Chicago conference. “It’s a very uncomfortable discussion. We should be willing to have it. Because we’re not having the conversation, only the people selling the drugs are weighing in on what they should cost.”
However, there are a number of reasons for the increased spending on cancer drugs. First, the progress that has been made by the current crop of treatments and cancer care regimens has led to the combination of earlier diagnosis and increased survival rates—at least for some period of time. In addition, some new drugs are enlisting the help of the human immune system to help fight cancer in the patient. This makes it possible to treat cancer as more of a chronic illness that can be managed by a combination of medication, surgery, lifestyle changes, and other factors. So, medical science seems to have brought about a murky state of affairs that is sort of a middle ground between cancer being the death sentence that it was in the past to being an extended, but mostly not curable, health problem. And, this period of survival has been accompanied by high medical and pharmaceutical costs. This emerging reality presents a conundrum that society will soon have to address.
For their part, insurers and prescription-drug benefits managers are trying to negotiate deals with pharmaceutical companies that would price the new drugs based on how well they work on various patients. This is part of a general trend toward pay-for-performance deals that are part of a strategy to mitigate the devastating effect of these astronomical prices. Pharmaceutical companies are generally countering with pricing models that offer free doses during a trial period.
Whatever the outcome, it seems that we are only now on the threshold of a what could become a new era of how cancer, and perhaps other diseases, are addressed by society.
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