[Mark11]

Dr. Rajkumar on the high cost of cancer drugs in the US

by Mark11 on Mon Mar 16, 2015 12:13 pm

Frequent Beacon contributor Dr. Rajkumar is co-author of a new paper titled "Why Are Cancer Drugs So Expensive in the United States, and What Are the Solutions?".

Here is an excerpt:

Established oligopolies and preventing Medicare from price negotiations are major factors causing high cancer drug prices. Other contributors include (1) strategies that delay or discourage competition by generic companies, such as “patent evergreening” (eg, creating new/extra patents on expired patents or prolonging patent life on minor variations of the original drug — new forms, new dosages or schedules, new combinations or combination variations)and “pay-for-delay” and “approved generics” (early introduction of generic drugs into the US market saved $1 trillion over 10 years), (2) preventing the Patient-Centered Outcomes Research Institute, which evaluates treatments for coverage by federal programs, from considering cost comparisons and cost-effectiveness, and (3) forbidding importation of drugs from abroad, even for personal use. The Canadian government’s Patented Medicine Prices Review Board estimated that US consumers pay 100% more for patented drugs than patients elsewhere.

Imatinib is priced at $92,000 per year (in 2012; $132,000 in 2014) in the United States, $46,000 in Canada, and $29,000 in Mexico. A recent example of the effects of “pay-for-delay” strategies is the successful move by Novartis to further delay the entry of generic imatinib into the US market from July 2015 until February 2016. This delay is estimated to cost US consumers and our health care system at least half a billion dollars.

These regulations may harm patients, impact the Medicare solvency and our health care system, increase insurance premiums, and hurt taxpayers. Why do they happen? Partly because of the pharmaceutical and health care industry lobbying power (an estimated 2500 lobbyists in 2012 and an estimated $306 million spent). Their spending far exceeds the lobbying spending of the defense, aerospace, and gas and oil companies."

Reference:

Hagop Kantarjian and S Vincent Rajkumar, "Why Are Cancer Drugs So Expensive in the United States, and What Are the Solutions?", Mayo Clinic Proceedings, March 2015 (link to full text of article)

[Nancy Shamanna]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Nancy Shamanna on Mon Mar 16, 2015 2:33 pm

Thanks, Mark11, for posting this informative link. It must be somewhat disconcerting to realize that the prices of the cancer drugs vary from country to country. My observation is that, even at lower prices, most of the drugs are priced beyond what a consumer could pay. Especially if one is on therapies for years, that would be a very high price to pay for medications! Thus, if one is to have those drugs, it must be through a government agency or a private insurance company.

Not all of the drugs available to treat myeloma in the US are available in Canada, though, so it isn't really possible to compare all drugs that way. Also, the restrictions put upon how drugs are used are not as onerous in the US, from what I read. For example, if a drug is approved here for a situ­a­tion of relapse, it would not be used in a first-line treatment. Government health care policy would not fund that.

There is bargaining power in a large group, and that is what a country can do when purchasing drugs. I think that, possibly in the US, there are many smaller groups, such as insurance com­pa­nies, purchasing individually from drug companies.

[Mark11]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Mark11 on Wed Mar 18, 2015 8:21 am

Hi Nancy S,

Hope you are doing great today.

Not all of the drugs available to treat myeloma in the US are available in Canada, though, so it isn't really possible to compare all drugs that way. Also, the restrictions put upon how drugs are used are not as onerous in the US, from what I read. For example, if a drug is approved here for a situ­a­tion of relapse, it would not be used in a first-line treatment. Government health care policy would not fund that."

That may be true, but, unfortunately, more access to the "latest and greatest" drugs does not lead to better outcomes for the healthcare system as a whole, according to the authors of the paper.

The health care industry in the United States is for-profit (unlike in European and other advanced nations), which appears to result in ill consequences driven by the demands for high profits: high drug prices (including cancer drugs) and high health care costs (18% of our gross domestic product vs 5%-9% in Europe). Despite the high level of spending, US health care outcomes are worse than those in other advanced nations."

The authors cited multiple studies to back that up.

With blood cancers specifically, healthy functioning immune systems appear to be the key to long-term remissions, as opposed to more drugs that typically lower immune function while patients are taking them.

Mark

[Nancy Shamanna]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Nancy Shamanna on Wed Mar 18, 2015 9:10 am

Hi Mark, You are quoting the same sort of stats that I have learned in advocacy workshops! In Canada, the percent of GDP is approximately 12%, and that varies from province to province, too.

Of course, if one has a healthy functioning immune system, that is the best case. Hope you are well also, and still doing well from your treatments taken a few years ago! (Allogeneic transplant?)

I think that, with myeloma, because of the mutant clones that spring up, we may need to have differing treatments as time goes on. Refractory and resistant disease is unfortunately a fact of life for many patients. That is why I am interested in any new drugs being approved here. Case in point, Pomalyst is now approved in the province of Ontario! This has to be good news for some patients!

I work away at being healthy, of course, since it is in my best interests to do so, in terms of my health. When people complain about the high costs of health care, I just like to think that medicine has made great progress in the last few years. Of course, those sorts of treatments cost more money than what was available previously, but, then again, the outcomes are better too! I thank our health care system for literally saving my life a few years ago. I hope that we can get the newer treatments here, too, that we read about on the Beacon.

[Ron Harvot]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Ron Harvot on Sun Apr 05, 2015 9:10 am

The Dallas Morning News has been running weekly articles about cancer and its costs. Today in the Sunday Easter edition, it ran a front page article on the cost of new cancer drugs. In that article they featured Dr. Hagop M. Kantarjian, MD with the MD Anderson Cancer Center in Houston, who co-authored the paper with Dr. Rajkumar that is mentioned at the beginning of this thread.

Dr. Kantarjian is a highly respected oncologist specializing in leukemia. He has been an outspoken critic of the exploding cost of new cancer drugs. He has been frustrated with the lack of political will and the willingness of our politicians to do nothing to stem the exploding costs faced by patients.

Here is a link to the article. The discussion by Dr. Kantarjian can be found at the end of the article.

http://www.dallasnews.com/business/health-care/20150403-runaway-cost-of-cancer-drugs-leaves-painful-choice-for-patients.ece

Ron

[Nancy Shamanna]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Nancy Shamanna on Sun Apr 05, 2015 5:32 pm

Thanks for posting that poignant article, Ron. In Canada, we don't know how much the drugs cost, since they are covered by government health care (guess we don't 'need to know' in a sense). We don't have as many drugs approved for use in cancer here as in the US, which concerns me. We have 'limited' options for myeloma drugs compared to in your systems.

But I can see why oncologists such as Dr. Rajkumar are alarmed by a 30% increase in drug costs in a year. It doesn't seem very sustainable actually.

Apparently the costs of antibiotics, being low, are preventing enough research being done to ensure that there will be enough varying types of antibiotics to treat infections in the future. That may be the 'breaking point' of health care – drug resistant bacteria! Sorry, not very cheerful news, but that is also a concern.

[Ron Harvot]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Ron Harvot on Tue Apr 07, 2015 9:18 am

Besides the article run on the front page of the Sunday Easter edition of the Dallas Morning News, the editorial board came out today with a call for change to combat the exploding cost of cancer drugs. The facts are undeniable. If cancer drug costs are not brought under control, then only the extremely wealthy patient will be able to afford them. Even with insurance, with more of the cost of treatment being pushed back to the patient, the costs will become too much.

The DMN is not a liberal paper. This editorial is not about liberal or conservative philosophy, it is about cold hard reality.

http://www.dallasnews.com/opinion/editorials/20150406-editorial-cancers-high-cost.ece

Ron

[Nancy Shamanna]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Nancy Shamanna on Tue Apr 07, 2015 10:29 am

I hope that some progress can be made in allowing your health care systems to negotiate pricing on drugs. Even so, they are so expensive as to be way beyond the financial reach of most people. The drugs I have been fortunate to have had 'prescribed' through my cancer centre, such as Revlimid and Velcade, are not as inexpensive as an antibiotic or other prescription, as I mentioned before. I AM very grateful to have had the costs of those drugs included in my health care here in Canada.

So, just as other health care – such as surgeries, labour and delivery units, neonatal intensive care nurseries, hospital units for palliative care or post operative care, and long term care for ill people – must be covered by our health care system, it is also the same with cancer treatments. I doubt that the individual could afford a stem cell transplant either, in most cases, or radiation therapies. Those aspects of health care require hospitals and care facilities. One good aspect of 'oral chemotherapies' is that one does not need hospital facilities for taking them (i.e. infusion centres). But that is not to say that drugs are not required to be taken by infusion, if that is the type one needs to have.

That is not quite the same with your systems, I think. But if cancer drugs were so expensive as to be only affordable by the very wealthy, there would no longer be a market for them, due to not enough people using them.

Probably since health care is not just a regular market place, government intervention would be required to moderate pricing so that the treatments are available to as many patients as possible!

[Bar-none]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Bar-none on Fri Jul 24, 2015 10:23 am

Greetings Beaconers,

It looks like efforts to reduce cost may be gaining traction. Cancer docs weigh in with recommended changes:

"Top Cancer Doctors Call for Lower Drug Costs," Time, July 23, 2015 (link to article)

The Mayo Clinic artice:

http://www.mayoclinicproceedings.org/pb/assets/raw/Health%20Advance/journals/jmcp/jmcp_pr90_7_5.pdf

Best! BN

[Mark11]

Re: Dr. Rajkumar on the high cost of cancer drugs in the US

by Mark11 on Fri Sep 18, 2015 4:08 pm

Here is a study recently published by UPENN in The Lancet with respect to the "financial toxicity" experienced by myeloma patients treated there.

"Out of the 100 patients from the Abramson Cancer Center who took part in the study, 59 percent labelled multiple myeloma treatment costs as higher than expected and 70 percent indicated at least minor financial burden. Thirty-six percent reported applying for financial assistance, including 18 percent of patients who reported incomes over $100,000.

Use of savings was common (43 percent), 21 percent borrowed money to pay for medications, and 17 percent reported delays in treatments due to costs. More than half had to reduce their hours at work or quit since their diagnosis. Ten patients stopped treatment altogether due to high costs.

Surprisingly, the study included patients with demographic characteristics likely to protect against financial burden. All participants were insured and all patients with Medicare fee-for-service coverage had additional supplemental insurance to assist with out-of-pocket costs. They also had a median household income and education level above national average. The median age was 64 and 53 percent were female. The median annual household income was reported between $60,000 and $79,999 and 70 percent reported having some college education.

"While enthusiasm surrounding modern advancements in cancer treatment is warranted, we must also acknowledge the untenable rise in treatment costs and its impact on patients," the authors write. "In the interim, strengthened collaboration among patients and health care stakeholders is needed to promote health care reforms that not only reward treatment innovation, but also promote high value and affordable cancer care." "
http://www.eurekalert.org/pub_releases/2015-09/uops-mmp091515.php