Rational Or Rationing? Saying No To A Cancer Med // Pharmalot

With all the talk of rising prices for cancer medications, the cost of healthcare and comparing the value and benefit of competing drugs, Memorial Sloan-Kettering Cancer Center has decided not to use a newly approved treatment for metastatic colorectal cancer. Specifically, the cancer center will not give patients Zaltrap, which is marketed by Sanofi (SNY) and Regeneron Pharmaceuticals (REGN) (see this).

Why? The price tag. ?The reasons are simple: The drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price ? at $11,063 on average for a month of treatment ? is more than twice as high,? write three doctors from the cancer center in an opinion piece in The New York Times.

In explaining their case, they note that FDA, Medicare and organizations that set physician guidelines pay attention to effectiveness; private insurers then follow suit, since they are expected to be held to the same standard. ?Ignoring the cost of care, though, is no longer tenable,? they write, adding they feel obligated to consider financial strains that result.

?This is particularly the case with cancer, where the cost of drugs, and of care over all, has risen precipitously,? they continue. ?The typical new cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000. Two of the new cancer drugs cost more than $35,000 each per month of treatment.?

?In 2006, one-quarter of cancer patients reported that they had used up all or most of their savings paying for care; a study last year reported that 2 percent of cancer patients were driven into bankruptcy by their illness and its treatment. One in 10 cancer patients now reports spending more than $18,000 out of pocket on care,? they continue.

As for Zaltrap, they explain that the drug offers the same survival benefit as Roche?s Avastin, which has a similar mechanism of action. ?When compared with the standard chemotherapy regimen alone, adding either medicine has shown to prolong patient lives by a median of 1.4 months. Major clinical practice guidelines, like those from the National Comprehensive Cancer Network, agree that Zaltrap is no better than Avastin in this setting,? they write.

But Avastin offers some advantages ? a monthly cost of $5,000, which is less than of the cost for Zaltrop, and it is takes less time to administer, while side effects are roughly equal. They then note that ?an older colorectal cancer patient without extra insurance would have to pay more than $2,200 out of pocket for a month?s treatment with Zaltrap.?

The problem, they say, is that the ?medical culture equates new with better, which can make a decision not to cover Zaltrap seem out of step. And they then complain that ?political rhetoric today is similarly slanted. Our refusal to adopt this remarkably expensive therapy risks being labeled rationing, not rational.?

They recognize that the decision may not have any meaningful effect, given that health care spending is so high and Zaltrap sales in the US are expected to amount to 0.005 percent of all dollars spent on health care next year. ?But it is a step in the right direction ? one of many we need to take,? they conclude.

Such sentiments are hardly uncommon these days, but they note that the rhetoric over health care explains why the Affordable Care Act precludes Medicare from changing its coverage or payment amounts based on cost comparisons. Comparative effectiveness has become a nasty phrase in some quarters and few insurers are willing to openly discuss the issue. We asked Sanofi for comment and will update you accordingly. Meanwhile, what do you think?

The authors are Peter Bach, who is the MSKCC director of the Center for Health Policy and Outcomes; Leonard Saltz, who is chief of the gastrointestinal oncology service and chairman of the pharmacy and therapeutics committee, and Robert Wittes, who is the physician in chief. Bach and Saltz disclose they have been paid consulting fees by Roche?s Genentech unit.

benjamins pic thx to amagill on flickr

Source: http://www.pharmalot.com/2012/10/rational-or-rationing-saying-no-to-a-cancer-med/

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