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Cancer drugs: Too expensive to compare?


By Sabriya Rice
Posted: April 17, 2014 - 8:15 pm ET
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The prices of some cancer drugs are so high that they preclude trials comparing their effectiveness, according to two National Cancer Institute researchers. A task force of clinical oncologists, meanwhile, is working on an algorithm for making such comparisons.

The NIH researchers, who penned a newly published perspectives piece for the New England Journal of Medicine, compared the brand and generic versions of two prostate cancer treatments and estimated it would cost nearly $70 million in drug costs alone to do a trial.

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It costs $500 to $700 per month to treat a patient with ketoconazole, a generic medication for prostate cancer, compared with $7,000 per month for Johnson & Johnson's Zytiga (whose generic name is abiraterone acetate). Insurers and government health programs would save more than $1 billion a year if just half of the patients who die of prostate cancer each year in the U.S. could be treated with the cheaper version, the authors said.

“It would be unwise, however, for Johnson & Johnson to fund such a study, since its findings could only erode the company's market share,” wrote Sham Mailankody and Dr. Vinay Prasad of the Medical Oncology Service at the National Cancer Institute.

“It is equally unlikely that the company would facilitate such a trial conducted by someone else by providing abiraterone free of charge,” they said. They estimated drug costs for a trial in the U.S. using those drugs would be $ 68,882,000.

At deadline for this story, Johnson & Johnson had not responded to a request for comment.

Mailankody and Prasad also estimated the cost of running trials for four other brands of next-generation cancer drugs, including Bristol-Myers Squibb Co.'s Taxol for metastatic pancreatic cancer, and Bayer HealthCare Pharmaceuticals' Stivarga for metastatic colorectal cancer.

Dr. Lowell Schnipper, chair of the American Society of Clinical Oncology's Value in Cancer Care Task Force, said the questions the authors raised reflect the type of problems his group discussed during a meeting Thursday.

“That basic idea is where we're heading,” he said in a phone interview, though he could not comment directly on the journal article. The ASCO task force is working to develop an algorithm evaluating factors that would include the clinical effectiveness and side effects associated with a treatment, and integrate those factors with the costs. It would potentially assign a value—which Schnipper said would describe the “optimal clinical outcome for our patients over the financial impact on the patient and society”—for each treatment.

“If a $7,000 drug is substantially better in some way, it would get a higher value score,” he said. “But if a lower cost treatment is very close or equivalent,” he added, “then, the answer to that is self-evident.”

The task force has been meeting with consultants and other experts in areas of value to develop an algorithm by the fall, although that timeline is tentative. In the meantime, the upcoming oncology meeting scheduled for May 30 through June 3 in Chicago will include a large number of educational and special sessions focused on the theme of cost and value.

“Drugs are so expensive that copays are very significant, and many patients end up mortgaging their house just to get cash to pay the copay,” Schnipper said. “Increasingly patients are being forced to bear the brunt, so we want to elevate the visibility of the issue.”

Follow Sabriya Rice on Twitter: @MHSRice


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