Two medical investigations within two days have called into question the extraordinary cost of cancer therapy, saying the ever-escalating price tags on the drugs is unsustainable.
Cancer medications are so expensive, both reports concluded, that the alarming costs have risen higher than inflation for more than a decade. The worrisome economics have given many doctors pause.
"The one thing we don't want to do is ration care," said Dr. Richard Lee, associate director of medical oncology at South Nassau Communities Hospital in Oceanside. Lee, who was not involved in either research project, said the cost of treatment worries doctors and patients alike.
The focus on cancer care's exorbitant costs was spotlighted in two revered medical journals this week. On Monday, a team of doctors reported in the The Journal of Clinical Oncology that they've developed a "framework" to judge a medication's value to patients using a scale of 0 to 100, with zero being worst.
Aiming for a "net health benefit," the team of cancer doctors from the American Society of Clinical Oncology awarded Eli Lilly's lung cancer drug, Alimta, a zero. The team cited low overall patient value based on a host of parameters, including the drug's cost -- more than $9,000 a month -- and Alimta isn't the most expensive.
Many cancer medications average about $10,000 a month and some cost over $25,000 every four weeks. The breast cancer drug Avastin runs nearly $12,000 a month compared with conventional chemotherapy, which costs about $200.
Tuesday, doctors from MD Anderson Cancer Center in Houston who riveted on the costs of leukemia and lymphoma drugs in the journal Cancer, said the majority of existing treatments for cancers of the blood are currently priced too high to be considered cost-effective.
One of the drugs evaluated in that research -- Gleevec, also known as imatinib -- cost about $26,000 per year of therapy in 2001. But Gleevec, a targeted therapy that treats chronic myeloid leukemia, now runs $132,000 per year of treatment.
Still, Gleevec's costs appear tame compared with other drugs highlighted in the research. Some based on novel molecules ranged from $210,000 annually to $426,000 -- and drugs in these lofty price categories have risen annually as well.
Jagpreet Chhatwal, one of the MD Anderson investigators, said price increases are not the result of improved versions of the medications, but of rising prices charged by drug companies.
He said high prices have placed substantial burdens on patients facing any one of numerous forms of blood cancers, such as Hodgkin lymphoma, chronic lymphocytic leukemia, non-Hodgkin lymphoma and multiple myeloma. Chhatwal said the price increases are astounding, given stagnant household incomes, many of which come nowhere near the cost of the medications.
Dr. Craig Devoe, acting chief of hematology and oncology at the North Shore-Long Island Jewish Health System's Monter Cancer Center in Lake Success, has taken his fight against high cancer-drug costs to Washington.
Last year, he and a coalition of cancer doctors met with New York legislators to discuss the escalating cost of undergoing cancer treatment on Long Island.
"I don't understand how the marketplace is bearing this," said Devoe, who noted that some forms of cancer immunotherapy can cost as much as $40,000 a dose.
While insurers and Medicare foot some of the bill, patients often are left bearing many of the costs, added Devoe who said drug expense can sometimes depend on how a medication is taken.
The emerging biologic drugs -- based on proprietary molecules -- must be infused in a treatment center. Those costs are usually assumed by insurers. But oral targeted therapies -- also based on proprietary molecules -- can dig deep into patients' wallets, he added.
Patients who take the pills can wind up paying $2,000 or more out of pocket in copays. "The pricing that pharmaceutical companies have put on the entire field of oncology is unsustainable," Devoe said.
Cancer drugs increase at a rate of about 12 percent a year, outstripping the rate of inflation. Dr. Craig Devoe, acting chief of hematology and oncology, Monter Cancer Center, said cancer patients are often burdened by copays.
-Cancer drugs increase, on average, $8,000 per year over the launch price of the drug. There is no cap.
-Two bills -- one in the House and another in the Senate, and backed by Long Island doctors -- could even out cost differences between infused and oral cancer drugs based on the same proprietary molecules. Currently, the oral medications cost more but are not biologically different.
-Patient-assistance programs run by pharmaceutical companies can help those who cannot afford medications.
-Cancer drugs are approved in Britain, for example, based on efficacy and cost. Cancer drugs are approved in the United States based on efficacy. Cancer medications cost substantially more here than the same drugs abroad.
-Medicare is not allowed to negotiate the cost of cancer medications with pharmaceutical companies, a consequence of laws enacted during the Bush administration.
Source: Newsday research