Wednesday, October 2, 2013
How much is a month of life worth?
This may be a strange question because prices for anything are determined by markets, and there is no market for a month of life – unless it is your life. Then the question is how much would you pay for that month or, how much would you ask your insurance company or Medicare to pay? I bring this up because of my concern (as well as many other people) about the cost of new cancer drugs. When I first began practicing oncology, it was an exciting time. Many new cancer chemotherapy drugs were being developed, and many of them had major benefits for patients. Also, they were not very expensive. We would be shocked if a course of therapy cost more than a few hundred dollars. A startling fact to me is that there are no more new chemotherapy drugs being introduced. All the new drugs being developed are so called “targeted therapies”. These are drugs that block certain aspects of a cancer cell’s ability to grow and divide. They tend to be appealing because they are often pills, and not associated with the well-known side effects of chemotherapy drugs such as nausea and hair loss. But they do have side effects. They are just not as dramatic. Also, there are two facts about these drugs that are important. First, on average, they rarely prolong life more than a couple of months in patients with widespread cancer. Second they are enormously expensive. Often they cost about $40,000 or more just for one extra month of life. And who knows how good the quality of life is that month? Many pharmaceutical drugs are expending a lot of effort into developing these drugs. The reason – its cancer – anything goes. Patients, desperate for any hope will grasp at these, no matter what the cost. And often, the cost is borne by insurance companies or Medicare. Rarely, the drugs do prolong life significantly and may be “curative”. In this situation the pharmaceutical companies will try to squeeze even more profit out of them. This applies to the drug “Gleevec” or imatinib. When this life-saving treatment for chronic myelogenous leukemia was first developed, it cost about $32,000 per year. An enormous price at that time (around 2001) but worth every penny. So what happened? The drug company making it has raised the price to nearly $100,000 per year. The greed of the pharmaceutical companies knows no bounds. And insurance companies and Medicare pay the price. I’m not sure what the answer to this problem will be. Some mechanism for controlling the price of these drugs will have to be found. Otherwise, as the population ages and more of us develop cancer, the burden of cost to Medicare may prove overwhelming.