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 At least half a dozen drugs, including colon cancer treatments
Cyramza, from Eli Lilly & Co, and Stivarga, sold by Bayer AG, aren't
worth prices that can exceed $100,000 a year, top cancer specialists
said in interviews with Reuters.
If specialists do start considering a drug's cost in their
prescribing habits, such decisions could dent the
multibillion-dollar cancer drug business of companies from Roche
Holding AG to Celgene Corp. Worldwide spending on cancer medicines
reached $100 billion in 2014, a year-over-year jump of more than 10
percent.
Doctors are unimpressed with so-called "me too" drugs developed by
companies looking to grab market share from a more established
product. They are also less likely to use a drug outside of its
approved indication for patients who have exhausted other types of
treatment.
"There are drugs that don't make much sense given how much they
cost, given their small benefits," said Dr Peter Bach, director of
Memorial Sloan Kettering's Center for Health Policy and Outcomes in
New York. "There are drugs that can cost up to $10,000 a month that
provide, at the median, a few weeks or less than a month of
additional life, but with substantial toxicity."
More than one-quarter of spending by Medicare, the federal health
insurance plan for seniors, is for services provided to
beneficiaries in their last year of life, according to the Kaiser
Family Foundation. Doctors say that, even with harsh side effects, a
few more weeks of life may be well worth the price to some patients.
For others, the potential benefits may not outweigh the costs.
Lilly's Cyramza was approved by U.S. regulators in April to treat
advanced colorectal cancer in combination with chemotherapy. It
works similarly to Roche Holding AG's much older drug Avastin and to
Sanofi SA's Zaltrap.
"Lilly got it on the market in stomach cancer (in 2014), which was a
very nice strategy since it was one of the few indications where
Avastin missed," said Dr. Leonard Saltz, chief of gastrointestinal
oncology at Memorial Sloan Kettering. But when Lilly put it on the
market for colon cancer, where it does compete with Avastin, they
kept its price at double the rate of the Roche drug. "In colon
cancer, I don't know anyone who is using it," Saltz said of Cyramza.
Even Avastin, which extends colon cancer survival by about 1.4
months compared to chemotherapy alone, is "massively overused and
massively overpriced," he said.
Dr. Lowell Schnipper, chief of haematology-oncology at Beth Israel
Deaconess Medical Center in Boston, also described Cyramza as
providing limited benefit at a cost of $7,000 to $9,000 a month.
Lilly said in an emailed statement that Cyramza addresses a high
unmet medical need, while Bayer said that Stivarga is an important,
and competitively priced, treatment option. Genentech, the U.S.
biotechnology unit of Roche, said it limits the annual cost of
Avastin to about $69,400 for its approved uses.
CAPPING EXPENSES
U.S. patients are paying a larger portion of their own health costs,
in the form of higher deductibles, co-payments and premiums. Some
insurance plans require patients pay up to 30 percent of the cost of
cancer drugs, although most also put a cap on those expenses. Under
President Barack Obama's Affordable Care Act, insurance policies
have total out-of-pocket limits of $6,600 for individual consumers
and $13,200 for families.
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Major medical groups including the National Comprehensive Cancer
Network and the American Society of Clinical Oncology are developing
ways to consider a drug's affordability in their treatment
decisions. But as they wait for firmer guidelines, some cancer
doctors are making what they view as some obvious changes. "In the
past, the cost implications of care were not on our radar until the
patient brought it up ... now we are much more sensitized to the
issue," said Dr. Neal Meropol, chief of haematology and oncology at
University Hospitals Seidman Cancer Center in Cleveland. Showing how
inefficient the current pricing system is, even when a drug is less
effective than a competitor, it doesn't necessarily cost less.
Of 51 cancer drugs approved between 2009 and 2013, 21 treatments
classified as "novel" had a median annual price of $116,100, while
the 30 deemed "next-in-class" had a median price of $119,765,
according to a recent study in the Journal of the American Medical
Association Oncology. At the same time, the cost of treatment is
rising steadily. In 1995 oncology patients and their insurers paid
$54,100 for an additional year of life, but by 2013 the price had
jumped to $207,000, according to a study sponsored by the National
Bureau of Economic Research. Saltz at Memorial Sloan Kettering said
Cyramza for colon cancer is a clear example of "a drug that costs
much more and does absolutely nothing," but said doctors may find it
harder to decide on a drug that "costs a lot and does very, very
little."
He views Stivarga in that category. "It costs around $12,000 to
$13,000 a month and makes people feel tired, causes skin rash on
hands and feet," he said. Insurers cover it, but require patients
pay a substantial amount upfront. "I used it a fair amount when it
first came out, but noticed that people didn't feel too good. I now
discuss it with patients and most decide not to use it."
Anthem Inc, the second largest U.S. health insurer, has a program to
steer oncologists toward effective treatments deemed to offer the
best value, paying them a monthly fee for adhering to a recommended
treatment regimen. Anthem cited drugs like Avastin and Celgene's
Abraxane as overused relative to their value. "Abraxane is a newer
version of an older (generic) drug called paclitaxel - they
basically do the same thing," said Dr. Jennifer Malin, medical
director for oncology at Anthem and an attending physician at the
Veterans Affairs Greater Los Angeles Health Care System.
One advantage of Abraxane is that it is less likely to cause
numbness. But Malin notes that a doctor can use paclitaxel first and
only switch to the more expensive drug if the patient experiences
that side effect.
Paclitaxel costs around $200 per dose compared with $10,000 for
Abraxane, she said. Celgene, which makes Abraxane, said it believes
the drug is a valuable treatment option.
(Reporting By Deena Beasley; Editing by Michele Gershberg and John
Pickering)
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