News (97-9).indd

When Will the U.S. Flinch at Cancer Drug Prices?
not responded to other treatments, based pinned on the targeted therapies—those that aim directly at cancer cells or that cut off a tumor’s blood supply without Erbitux (cetuximab), Tarceva (erlotinib), Colon Cancer Leads the Way
Still, the future will likely bring more priced at thousands of dollars per month therapies. Tarceva and Avastin are being add-ons to other therapies. Clinicians are studied together and in combination with other drugs in renal cell, lung, and breast question,” said Bruce E. Hillner, M.D., Access to Care
Otis Brawley
cost-effectiveness analyses for 15 years. survival by 4.5 months over the standard W. Brawley, M.D., treats cancer patients He said the response he usually gets is, therapy of IFL (irinotecan, fl uorouracil, “Yes, Dr. Hillner, it’s nice of you to call Institute and at Grady Hospital, a large our attention to these issues, but let’s clinical trial found that Avastin added to public hospital in Atlanta. “I have had to therapies,” Hillner explained. “We’re with a steep price increase, according to a New England Journal of Medicine we’re uncertain about the benefi ts.” ploying an additional nurse practitioner Center in New York. ( See box, p. 625.) counter that the drugs are expensive to fl uorouracil plus leucovorin to $11,889 “It’s hard to put a value on extending lives, which these drugs do,” said Nikki Levy, Genentech’s manager of corporate the drug. He typically treats his prostate relations. She explained that the method used to develop biologicals is a factor in biologic therapies are produced in living case. “Patients were offered orchiectomy or were told, ‘if you can fi nd the money, Journal of the National Cancer Institute, Vol. 97, No. 9, May 4, 2005 the incremental cost-effectiveness ratio vate practice oncologists are facing the fell well within the range of acceptable ( see News, Vol. 97, No. 2, p. 86 , cancer, Brawley said, at incredible costs. “Are we going to treat these people with colon cancer or have a hospital that can health care leaders. Payers aren’t deny- in,” Hillner said. He added that there therapy, are facing the question a lot,” ing better prices with drug companies. In including Avastin, Iressa, and Tarceva— leagues projected the cost-effectiveness demonstration project. ( See News, Vol. 97, therapy for metastatic colorectal cancer In a Washington Post editorial, less in 2005 and beyond. ( See News, sive, averaging $80,000 per life-year, but the cost was consistent with other inter- price controls “if the industry fails to ventions widely accepted in oncology. For newest therapies. Clinicians are balking a survival gain of 4.4 months, the cost per business of limiting care based on cost. although it has shown a disease-free sur- that’s pretty pricey, and are we as a soci- ety acting very rationally?” Hillner noted. able as a pharmaceutical benefi t, based on benefi t and fi nancial cost. The United tase inhibitor, can cost $200 per month. Atlanta, brought a societal perspective Kingdom relies on the National Institute American Journal of Public Health . more on the ‘technology’ of care (e.g., the price of tamoxifen, for less than 5% of patients,” Brawley said. “It’s a huge question mark. We are very selectively Rising Costs of Chemotherapy
using Arimidex for women at very high risk of relapse. The majority who get Last year, Deborah Schrag, M.D., wrote an editorial in the New England Journal of Medicine that raised concerns about the rising costs of the newer targeted chemotherapy drugs. Using the May 2004 average wholesale price of chemotherapy drugs, she estimated the costs of different regimens for 8 weeks of treatment for metastatic colorectal cancer: more and more toward Arimidex, we are going to have pressure to go spend that Drug Costs ($)
Monthly bolus of fl uorouracil plus leucovorin Societal Costs
Weekly bolus of fl uorouracil plus irinotecan (IFL) Leucovorin and fl uorouracil plus oxaliplatin (FOLFOX) sions about the care they can offer, cost- Source: N Engl J Med 2004;351:317 – 19. Journal of the National Cancer Institute, Vol. 97, No. 9, May 4, 2005 drug prices; 70% of those people support more regulation, even if it leads to less cardiovascular disease. “I don’t think oncology is going to lead the charge.” —Cori Vanchieri
Journal of the National Cancer Institute, Vol. 97, No. 9, May 4, 2005

Source: http://physio.vipbg.vcu.edu/~vipbg/psy691/JNCI_2005.pdf