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Many cancer drugs are way over that mark. Estimates of the cost of a year of life gained for lung cancer patients on Erbitux range from $300,000 to as much as $800,000, said Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer.
Higher costs seem to be more accepted for cancer treatment than for other illnesses, but there's no rule on how much is too much, he said.
Insurers usually are the ones to decide, and they typically pay if Medicare pays. Medicare usually pays if the federal Food and Drug Administration has approved the use.
"Insurance sort of isolates you from the cost of health care," and if people lose coverage, they often discover they can't afford their medicines, said Dr. Alan Venook, a cancer specialist at the University of California, San Francisco. He wrote in the New England Journal in August about three of his patients who stopped taking or cut back on Gleevec because of economic hardship.
Two of the three now are getting the drug from its maker, Novartis AG, which like most pharmaceutical companies has a program for low-income patients. About 5,000 patients got help for Gleevec last year, said Novartis spokesman Geoffrey Cook.
"We have seen a steady increase in requests over the past few years" as the economy worsened, he said.
Showstack, whose leukemia was diagnosed last year, gets Gleevec from Novartis. The dose she's on now would cost $50,000 a year.
"I'm not actually sure that I know anyone who could afford it," she said.
Gleevec's cost is easier to justify, many say, because it keeps people alive indefinitely -- a virtual cure. About 2,300 Americans died each year of Showstack's form of leukemia before Gleevec came on the market; only 470 did last year.
"I don't think we quibble with a drug that buys people magical quality of life for years," Venook said.
It's unclear whether Provenge will ever do that -- it needs to be tested in men with earlier stages of prostate cancer, doctors say. So far, it has only been tried and approved for men with incurable disease who have stopped responding to hormone therapy. On average, it gave them four months more, though for some it extended survival by a year or more.
Until it shows wider promise, enthusiasm will be tepid, said Dr. Elizabeth Plimack a prostate specialist at the Fox Chase Cancer Center in Philadelphia.
"I've not had any patient ask for it," she said. "They ask about it. Based on the information, they think the cost is tremendous, and they think the benefit is very small."
Logothetis, at M.D. Anderson, said Provenge and other experimental cancer vaccines in development need "a national investment" to sort out their potential, starting with Medicare coverage.
"It's no longer a fringe science. This is working," he said. "We need to get it in the door so we can evolve it."
Where to get help:
Patient Advocate Foundation, 800-532-5274:
Chronic Disease Fund, 877-968-7233:
HealthWell Foundation, 800-675-8416:
Leukemia & Lymphoma Society, 877-557-2672:
National Organization for Rare Disorders 800-999-6673: http://www.rarediseases.org/
Patient Access Network Foundation, 866-316-7263: http://www.panfoundation.org/
Patient Advocate Foundation, 866-512-3861:
Patient Services, Inc., 800-366-7741:
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