Cancer Drugs in the United States: Justum Pretium—The Just Price
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TLDR
In the context of cancer therapy, the prices of new anticancer agents seem to be decided by pharmaceutical companies according to what the market will bear as discussed by the authors, and there is little correlation between the actual efficacy of a new drug and its price, as measured by cost-efficacy (CE) ratios, prolongation of patient life in years, or quality-adjusted life-years (QALYs)Abstract:
In 2011, health care spending in the United States was estimated at $27 trillion,1 making it the sixth largest economy in the world, larger than the national budget of France National health care spending is approximately 18% of the US gross domestic product, more than $8,000 per person, compared with 6% to 9% in Europe and elsewhere, with apparently similar patient outcomes Total Medicare expenditures in 2011 were $549 billion2 A study comparing the Canadian universal health care program in older patients with the Medicare program in the United States suggested that adopting more-prudent health care strategies could have saved $256 trillion from 1980 to 2009, or approximately one fifth of our national debt, without compromising benefit3
In the debate about health care and Medicare solvency, strategies that reduce health care costs without compromising treatment efficacy and patient safety should be explored Several experts have addressed health care costs in excellent analyses and editorials,4–9 but their efforts have not translated into concrete decisions and results that benefit patients, providers, insurers, or payees However, an interesting exception occurred recently when Bach et al,10 in a New York Times editorial, compared the efficacy and cost of two anticancer agents—ziv-aflibercept (Zaltrap; sanofi-aventis, Bridgewater, NJ) and bevacizumab (Avastin; Genentech, South San Francisco, CA)—in the treatment of metastatic colorectal cancer After noting ziv-aflibercept had similar efficacy but was twice the cost of bevacizumab, they stated it would be excluded from their hospital formulary10 Within 1 week, sanofi-aventis, the company producing ziv-aflibercept, reduced its price by 50% Thus, expert review of anticancer therapies for their cost-benefit ratios may influence institutional usage and drug pricing while preserving a healthy profit margin for pharmaceutical companies
Aristotle is credited to be the first to discuss the relationship between price and worth in his book Justum Pretium—the just price Sixteen centuries later, Saint Albert the Great and Saint Thomas Aquinas refined Aristotle's argument Their conclusion: of moral necessity, price must reflect worth In the context of cancer therapy, the prices of new anticancer agents seem to be decided by pharmaceutical companies according to what the market will bear There is little correlation between the actual efficacy of a new drug and its price, as measured by cost-efficacy (CE) ratios, prolongation of patient life in years, or quality-adjusted life-years (QALYs)7 Compared with a decade ago, the price range of new anticancer agents has more than doubled, from $4,500 to more than $10,000 per month4,5 Of the 12 anticancer drugs approved by the US Food and Drug Administration (FDA) in 2012, only three prolonged survival, two of them by less than 2 months Yet nine were priced at more than $10,000 per month Many so-called targeted therapies have been priced between $6,000 to 12,000 per month, or approximately $70,000 to 115,000 per patient annually (Table 1)11 However, novel or reformulated chemotherapy drugs like pralatrexate (Folotyn; Allos Therapeutics, Westminster, CO; $120,000 per course), omacetaxine (Synribo; Teva Pharmaceuticals, North Wales, PA; $28,000 for induction, $14,000 for monthly treatments), and pegylated asparaginase (Oncaspar; Sigma-Tau Pharmaceuticals, Gaithersburg, MD; $22,000 per course) are also expensive Hillner and Smith7 suggested that profiteering (ie, making profit by unethical methods, such as raising prices after natural disasters) could be applied to this recent trend, where a life-threatening disease is the natural disaster
Table 1
Cost of Targeted Therapy
Pharmaceutical companies justify the high price of drugs as necessary to support investment in research and development The often-cited cost of bringing anticancer drugs to FDA approval is $1 billion12 This figure is roughly calculated by dividing total expenditures on research and development by the number of agents that receive FDA approval However, this figure may be inflated, because it includes ancillary expenses, salaries, bonuses, and other indirect costs not related to research or development13 as well as an 11% compounded discount rate over 10 years based on stock market returns on capital investment14 Other independent estimates of cost of drug development put the figure as low as 4% to 25% of this estimate15–17
Allowing the producer-dominated market to set drug prices has spiraled the cost of cancer drugs out of control In this analysis, we highlight examples of the cost benefit of different anticancer agents and suggest scenarios for reduced drug pricing, while preserving the profit-making incentive, by linking price to a true measure of quality: preservation and meaningful prolongation of liferead more
Citations
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Journal ArticleDOI
High Cancer Drug Prices in the United States: Reasons and Proposed Solutions
TL;DR: If high prices make drugs unaffordable and inaccessible, thus causing harm, then the authors should voice their concerns and advocate for solutions, and it is also their obligation as cancer doctors to keep patients from "harm and injustice."
Journal ArticleDOI
Barriers for Access to New Medicines: Searching for the Balance Between Rising Costs and Limited Budgets.
Brian Godman,Anna Bucsics,Patricia Vella Bonanno,Wija Oortwijn,Wija Oortwijn,Celia C. Rothe,Alessandra Ferrario,Simone Bosselli,Andrew Hill,Antony P. Martin,Steven Simoens,Amanj Kurdi,Amanj Kurdi,Mohamed Gad,Jolanta Gulbinovič,Angela Timoney,Angela Timoney,Tomasz Bochenek,Ahmed Salem,Iris Hoxha,Robert Sauermann,Amos Massele,Augusto Alfonso Guerra,Guenka Petrova,Zornitsa Mitkova,Gnosia Achniotou,Ott Laius,Catherine Sermet,Gisbert Selke,Vasileios Kourafalos,John Yfantopoulos,Einar Magnusson,Roberta Joppi,Margaret Oluka,Hye Young Kwon,Arianit Jakupi,Francis Kalemeera,Joseph O Fadare,Øyvind Melien,Maciej Pomorski,Magdalene Wladysiuk,Vanda Marković-Peković,Vanda Marković-Peković,Ileana Mardare,Dmitry Meshkov,Tanja Novakovic,Jurij Fürst,D Tomek,Corrine Zara,Eduardo Diogene,Johanna C Meyer,Rickard E. Malmström,Björn Wettermark,Björn Wettermark,Zinhle Matsebula,Stephen Campbell,Alan Haycox +56 more
TL;DR: The primary aim of this paper is to consider potential ways to optimize the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective.
Journal ArticleDOI
Impact of Ibrutinib and Idelalisib on the Pharmaceutical Cost of Treating Chronic Lymphocytic Leukemia at the Individual and Societal Levels
Tait D. Shanafelt,Bijan J. Borah,Heidi D. Finnes,Kari G. Chaffee,Wei Ding,Jose F. Leis,Asher Chanan-Khan,Sameer A. Parikh,Susan L. Slager,Neil E. Kay,T. G. Call +10 more
TL;DR: Although ibrutinib and idelalisib are profound treatment advances, they will dramatically increase individual out-of-pocket and societal costs of caring for patients with CLL and may undermine the potential promise of these agents by limiting access and reducing adherence.
Journal ArticleDOI
Critical care of patients with cancer
Alexander Shimabukuro-Vornhagen,Boris Böll,Matthias Kochanek,Éli Azoulay,Michael von Bergwelt-Baildon +4 more
TL;DR: A review of the state-of-the-art in the individualized management of critically ill patients with cancer can be found in this article, where the authors provide an overview of the current state of the art in this area.
Journal ArticleDOI
Why Are Cancer Drugs So Expensive in the United States, and What Are the Solutions?
TL;DR: The high cost of cancer drugs, the reasons for these high prices, the implications for patients and the health care system, and potential solutions to the problem are discussed.
References
More filters
Journal ArticleDOI
Improved Survival with Ipilimumab in Patients with Metastatic Melanoma.
F. Stephen Hodi,Steven J. O'Day,David F. McDermott,R. W. Weber,Jeffrey A. Sosman,John B. A. G. Haanen,Rene Gonzalez,Caroline Robert,Dirk Schadendorf,Jessica C. Hassel,Wallace Akerley,Alfons J.M. van den Eertwegh,Jose Lutzky,Paul Lorigan,Julia Vaubel,Gerald P. Linette,David W. Hogg,Christian H. Ottensmeier,Céleste Lebbé,Christian Peschel,Ian Quirt,Joseph I. Clark,Jedd D. Wolchok,Jeffrey S. Weber,Jason Tian,Michael Yellin,Geoffrey M. Nichol,Axel Hoos,Walter J. Urba +28 more
TL;DR: Ipilimumab, with or without a gp100 peptide vaccine, as compared with gp100 alone, improved overall survival in patients with previously treated metastatic melanoma.
Journal ArticleDOI
Improved Survival with Vemurafenib in Melanoma with BRAF V600E Mutation
Paul B. Chapman,Axel Hauschild,Caroline Robert,John B. A. G. Haanen,Paolo A. Ascierto,James Larkin,Reinhard Dummer,Claus Garbe,Alessandro Testori,Michele Maio,David W. Hogg,Paul Lorigan,Céleste Lebbé,Thomas Jouary,Dirk Schadendorf,Antoni Ribas,Jeffrey A. Sosman,John M. Kirkwood,Brigitte Dréno,K. B. Nolop,Jiang Li,B. Nelson,Jeannie Hou,Richard J. Lee,Keith T. Flaherty,Grant A. McArthur +25 more
TL;DR: Vemurafenib produced improved rates of overall and progression-free survival in patients with previously untreated melanoma with the BRAF V600E mutation in a phase 3 randomized clinical trial.
Journal ArticleDOI
The price of innovation: new estimates of drug development costs
TL;DR: The research and development costs of 68 randomly selected new drugs were obtained from a survey of 10 pharmaceutical firms and used to estimate the average pre-tax cost of new drug development.
Journal ArticleDOI
Ipilimumab plus Dacarbazine for Previously Untreated Metastatic Melanoma
Caroline Robert,Luc Thomas,Igor Bondarenko,Steven J. O'Day,Jeffrey S. Weber,Claus Garbe,Céleste Lebbé,Jean Francois Baurain,Alessandro Testori,Jean-Jacques Grob,Neville Davidson,Jon M. Richards,Michele Maio,Axel Hauschild,Wilson H. Miller,Pere Gascón,Michal Lotem,Kaan Harmankaya,Ramy Ibrahim,Stephen Francis,Tai-Tsang Chen,R. Humphrey,Axel Hoos,Jedd D. Wolchok +23 more
TL;DR: Ipilimumab (at a dose of 10 mg per kilogram) in combination with dacarbazine, as compared with dACarbazine plus placebo, improved overall survival in patients with previously untreated metastatic melanoma.
Journal ArticleDOI
Erlotinib Plus Gemcitabine Compared With Gemcitabine Alone in Patients With Advanced Pancreatic Cancer: A Phase III Trial of the National Cancer Institute of Canada Clinical Trials Group
Malcolm J. Moore,David Goldstein,John T. Hamm,Arie Figer,J. R. Hecht,Steven Gallinger,Heather J. Au,Pawel Murawa,David Walde,Robert A. Wolff,D. M. B. Campos,Robert Lim,Keyue Ding,Gary M. Clark,Theodora Voskoglou-Nomikos,Mieke Ptasynski,Wendy R. Parulekar +16 more
TL;DR: To the authors' knowledge, this randomized phase III trial is the first to demonstrate statistically significantly improved survival in advanced pancreatic cancer by adding any agent to gemcitabine.
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