Wednesday, August 26, 2015

Cancer Drugs-Cost Versus Benefit the New Paradigm

Recently, both the New York Times and the Los Angeles Times have published articles about oncologists' new consumer tool to gauge the effectiveness of cancer drugs. This effort was spurred after harsh rebukes of the pharmaceutical industry from clinicians at the Mayo Clinic and Harvard Medical School.  Both of the "Times" articles cite information from the Journal of the American Medical Association (JAMA) article, which ranked cancer fighting drugs from 2009 through 2013 for effectiveness and cost. (1) Oncologists have embraced this new consumer decision aide as it provides health care purchasers and their families with another basis for decision making. And, as it often turns out, the most expensive medication is not necessarily the most effective. Using a scale of 0 to 130 rating system, the cancer drug treatments are ranked for efficacy. Here are the most expensive oncology medications, based on the analysis of experts at JAMA in this study, costs are expressed annually and their effectiveness ranking is listed below:
       RX Ranking by cost-
  1. Omacetaxine for chronic myeloid lukemia-$168,366
  2. Ibrutinib for mantle cell lymphoma-$157,440
  3. Crizotinib for non-small cell lung cancer-$156,544
  4. Pomalydomide for multiple myeloma-$150,408
  5. Sorafenib for papillary thyroid cancer-$141,984
  6. Regorafenib for colorectal cancer-$141,372
  7. Ponatinib for chronic myeloid lukemia-$137,592
  8. Trametinib for malignant melanoma-$125,280
  9. Lenalidomide for mantle cell lymphoma-$124,870
  10. Cabozantinib for medulliary thyroid cancer-$118,800
      Same RX showing effectiveness and extended life expectancy due to drug observed response
     Note that some of the drugs lack a proportional effectiveness ranking, this is not an omission.
     Observed effects are quoted from the JAMA article findings.
  1. Omacetaxine for chronic myeloid lukemia-14.3% effectiveness, 12.5 months median observed effect
  2. Ibrutinib for mantle cell lymphoma-66% effectiveness, 17.5 months median observed effect
  3. Crizotinib for non-small cell lung cancer-7.7 months median observed effect versus 3 months on other treatment
  4. Pomalydomide for multiple myeloma-29% effectiveness,7.4 months median observed drug effect
  5. Sorafenib for papillary thyroid cancer-10.8 months median observed effect versus 5.8
  6. Regorafenib for colorectal cancer-2 months median observed drug effect versus 1.7 for other
  7. Ponatinib for chronic myeloid lukemia-54% effectiveness, 3.2 to 9.5 months median observed drug effect
  8. Trametinib for malignant melanoma-4.8 months versus 1.5 median observed effect
  9. Lenalidomide for mantle cell lymphoma-26% effectiveness, median observed effect 16.6 months
  10. Cabozantinib for medulliary thyroid cancer-11.2 months median observed effect versus 4 months
As you can see, a high price tag does not assure a fantastic response rate, especially when compared to plain old chemotherapy. Or for example, the non-small cell lung cancer drug, Erlotinib (Tarceva) scored a 44% effectiveness rate and costs $4,600 per month versus the outrageously priced Crizotinib at more than twice that price. Also in comparison, the widely marketed Avastin drug for lung cancers scored only a 16% effectiveness ranking, and it costs $12,000 a month. (2)

Oncologists have banded together to create a Value Framework (3) from which patients and their families can assess the total efficacy of a cancer drug, including cost, response to drug, and a comparison to other treatments. This welcome tool is called a decision aide and it is the latest trend in getting health care quality and purchasing information to the individual patients.

Concern for the efficacy of health care treatments is being expressed by governments as well, with multiple states passing laws requiring drug companies to share their development cost data and not just the drug price. California, Massachusetts, North Carolina, Oregon, and Pennsylvania all have bills pending for pharmaceutical transparency and disclosure. (4) This is all part of the increased effort for greater transparency in health care, driven to the consumer, who actually has to pay for the insurance, the treatments, or the taxes for all of the above.  Although the pharmaceutical pricing model is price-to-whatever-the-U.S.-market-will-bear, this is increasingly becoming a free fall for the consumer who can't afford the treatment and for publicly funded health care programs which are balking at the price gouging.

In 2013, in my book, I wrote about discerning quality in health care services and this is one more step in empowering patients and their families to make better decisions for their health treatments. To increase your health purchasing IQ continue to read what the healthpolicymaven has to say.  Other articles which may be of interest include:

And this is the healthpolicymaven signing off. This article does not offer medical advice and may be shared virally, with appropriate attribution to the writer of course. The healthpolicymaven is a graduate of the University of Washington School of Public Health and Community Medicine and the Daniel Evans School of Public Affairs.

(1) Sham Mailankody, MB BS1; Vinay Prasad, MD, MPH,  Five Years of Cancer Drug Approvals, Innovation, Efficiency, and Costs, JAMA, July 2015, Volume 1 No. 4

(2) Melissa Healy, Cancer Drugs get a new consumer's guide, Science Now, The Los Angeles Times, June 22, 2015

(3)   Lowell E. Schnipper, Nancy E. Davidson, Dana S. Wollins, et, al. American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options,
American Society of Clinical Oncology, August 2015

 (4) Andrew Pollack, Drug Prices Soar, Prompting Calls for Justification, The New York Times, July 23, 2015