CHICAGO — Although the theme of the ASCO Annual Meeting this year is “Illumination and Innovation,” one oncologist responded to the excitement over breakthrough research by calling for a sweeping change in how costs are determined for novel cancer treatments.
Leonard Saltz, MD, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center and a HemOnc Today Editorial Board member, discussed the high cost of current cancer drugs in the United States during the ASCO plenary session.
“As a researcher, I am deeply gratified to see how basic science has been elegantly translated into useful drugs that are benefitting patients today,” Saltz said. “As a clinician who treats many patients, I want these drugs and drugs like them available for my patients. And, as one who worries about how we are going to make cancer care at the highest levels available to everyone and minimize disparities in health care as much as possible, I have a major problem — and that is, these drugs cost too much.”
Saltz highlighted one of the featured presentations at the ASCO meeting — a study conducted by Wolchok and colleagues that demonstrated the addition of nivolumab (Opdivo, Bristol-Myers Squibb) to ipilimumab (Yervoy, Bristol-Myers Squibb) significantly improved PFS for patients with melanoma (Abstract LBA1. Presented at: ASCO Annual Meeting; May 29-June 2, 2015; Chicago.) — and broke it down by cost.
Saltz pointed out that the cost of nivolumab is $28.78 per milligram and the cost of ipilimumab is $157.46 per milligram.
“That is approximately 4,000 times the cost of gold,” he said.
Thus, the cost for an entire year of combination treatment for one individual would equate to $295,566, Saltz said. Because many insurance plans require a 20% copay, patients eligible for that treatment would pay approximately $60,000 for one year of treatment, he said.
“Cancer drug prices are not related to the value of the drug,” Saltz said. “Rather, prices are based on what has come before and what the seller believes the market will bear.”
Saltz called that practice “unsustainable.”
Using the drug pembrolizumab (Keytruda, Merck) as another example, Saltz indicated that the approved 2-mg/kg dose is $14,500 for 1 month of treatment. He then noted that several abstracts presented at the annual meeting evaluated a 10-mg/kg dose of pembrolizumab, which would equate to a price tag of more than $1 million per year for an individual patient.
“The unsustainably high prices of cancer drugs is a big problem, and it’s our problem,” Saltz said.
Saltz called on the pharmaceutical industry, the insurance industry and the medical community to work with the federal government to resolve the issue.
"Too often, discussions about medicine costs ignore the competitive biopharmaceutical market that exists in the U.S., which keeps a check on spending growth while spurring the development of innovative new therapies for patients,” Robert Zirkelbach, senior vice president of Pharmaceutical Research and Manufacturers of America (PhRMA), told HemOnc Today. “Spending on retail prescription medicines accounts for just 10% of total U.S. health care spending and spending on cancer medicines represents just 1% of that total. High utilization rates of generics, competition among brand-name medicines and aggressive tactics by insurers to negotiate prices all help to keep costs under control.”
Value for patients may need to be a key focus when discussing drug costs.
“This has led to tremendous — and sustainable — progress against cancer, including dramatic declines in cancer death rates and improved quality of life for patients,” Zirkelbach said. “Conversations about costs needs to move beyond sound bites and focus on the tremendous value that new innovative medicines are providing to patients, the health care system and society — both today and in the long run."
Saltz noted ASCO would be releasing its framework to assess the value of cancer care on June 22, but added that cost should be considered a “financial toxicity” and should be assessed with other toxicities when treatments are considered by doctors and patients.
He also offered several alternative options to try and control prices, including allowing Medicare to negotiate with pharmaceutical companies, which is currently not allowed by the federal law. He also suggested a tiered system that would put less of a price on more effective drugs and a higher price on less effective drugs, or incentivized treatment options that would make a drug free to a patient for the first 2 to 3 months.
He concluded by quoting Dr. Seuss.
“Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not,” Saltz said. – by Anthony SanFilippo