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The Rising Costs of Cancer Drugs
http://nymag.com/news/features/cancer-drugs-2013-10/Cancer drugs have become a very big business, even though they serve what one expert has described as a “boutique” market. An estimated 1.7 million Americans will be diagnosed with cancer this year, according to the National Cancer Institute, and more than 580,000 people will die from some form of malignancy. In 2012, the overall market for “oncologics” reached nearly $26 billion a year in the U.S. alone, and annual global sales are projected to total $85 billion by 2016, according to the IMS Institute for Health Informatics.
What is sobering about this booming business is that, as a group of oncologists wrote earlier this year, “most anti-cancer drugs provide minor survival benefits, if at all.” They often (but not always) reduce the size of inoperable tumors, but they rarely eradicate the disease. For relatively uncommon malignancies like testicular cancer, some forms of leukemia, and lymphoma, drugs effectively cure the disease; for the common “solid tumor” cancers (lung, breast, colon, prostate, and so on), which account for the vast majority of annual cases, drugs buy some time—precious time, to be sure, but time usually measured in weeks and months rather than years. And even though many of the newer drugs are less toxic, they often still have to be given with older drugs whose side effects include nausea, hair loss, fatigue, and decreasing blood counts. One anti-cancer drug produces a skin rash so severe and disturbing, according to Saltz, that some patients have been asked by employers not to come to work.
In 1965, at the dawn of Medicare, the chemotherapy drug Vinblastine cost $78 a month, according to a widely cited Sloan-Kettering price compendium. In 2011, Bristol-Myers Squibb introduced a new melanoma drug called Yervoy at a cost of about $38,000 a month for a three-month treatment.* Yervoy followed, by about a year, a new prostate-cancer therapy called Provenge that cost $93,000 per course of treatment. Even an ancient chemotherapy like nitrogen mustards, cousins to World War I’s mustard gas and in use since 1949, have gotten caught in the cost updraft; in 2006, a course of treatment experienced a thirteenfold price increase, from $33 a month to $420 a month.
And it’s not just that the price of cancer drugs has doubled in the last decade—it’s that the rise in prices, according to cancer doctors, has far exceeded the drugs’ effectiveness. In 1994, the median survival rate for someone with advanced colon cancer was eleven months, according to Saltz, and the lifetime costs of the drugs used to treat the average patient would be about $500 at today’s prices. By 2004, the median survival rate had increased twofold, to 22 months, but Saltz says the drug costs had increased hundreds of times for that extra eleven months.
What is sobering about this booming business is that, as a group of oncologists wrote earlier this year, “most anti-cancer drugs provide minor survival benefits, if at all.” They often (but not always) reduce the size of inoperable tumors, but they rarely eradicate the disease. For relatively uncommon malignancies like testicular cancer, some forms of leukemia, and lymphoma, drugs effectively cure the disease; for the common “solid tumor” cancers (lung, breast, colon, prostate, and so on), which account for the vast majority of annual cases, drugs buy some time—precious time, to be sure, but time usually measured in weeks and months rather than years. And even though many of the newer drugs are less toxic, they often still have to be given with older drugs whose side effects include nausea, hair loss, fatigue, and decreasing blood counts. One anti-cancer drug produces a skin rash so severe and disturbing, according to Saltz, that some patients have been asked by employers not to come to work.
In 1965, at the dawn of Medicare, the chemotherapy drug Vinblastine cost $78 a month, according to a widely cited Sloan-Kettering price compendium. In 2011, Bristol-Myers Squibb introduced a new melanoma drug called Yervoy at a cost of about $38,000 a month for a three-month treatment.* Yervoy followed, by about a year, a new prostate-cancer therapy called Provenge that cost $93,000 per course of treatment. Even an ancient chemotherapy like nitrogen mustards, cousins to World War I’s mustard gas and in use since 1949, have gotten caught in the cost updraft; in 2006, a course of treatment experienced a thirteenfold price increase, from $33 a month to $420 a month.
And it’s not just that the price of cancer drugs has doubled in the last decade—it’s that the rise in prices, according to cancer doctors, has far exceeded the drugs’ effectiveness. In 1994, the median survival rate for someone with advanced colon cancer was eleven months, according to Saltz, and the lifetime costs of the drugs used to treat the average patient would be about $500 at today’s prices. By 2004, the median survival rate had increased twofold, to 22 months, but Saltz says the drug costs had increased hundreds of times for that extra eleven months.
This tells the story of Sloan-Kettering refusing to use a drug because it cost $700K to add on average 40 days of life expectancy.
Not sure what to say about that, but it's definitely a problem. Particularly troubling is that the drug makers sell the drugs wholesale to the oncologists, who then resell them to the patients.