A Response to "Blood" editorial, "The Price of Drugs for Chronic Myeloid Leukemia"
Cancer Medicines Are Worth It
04.25.13 | By Matt Bennett
Cutting edge cancer treatments offer patients hope in their battle against devastating diseases. They typically treat some of the most severe or rare diseases, where previously there were inadequate options. Since 1980, life expectancy for cancer patients has increased by about three years and over 80 percent of those gains are attributable to new treatments, including medicines.
The authors of the Blood editorial, “The Price of Drugs for Chronic Myeloid Leukemia,” note that the 10-year survival for chronic myeloid leukemia (CML) patients has increased from less than 20% to more than 80%, but question whether the cost of cancer medicines is worth it.
When considering cost, the tremendous value of medicines in the larger healthcare system cannot be overlooked. According to recent data from IMS Health, spending on oncologic medicines represented less than 1% of total national health expenditures in 2010. Additionally, only 14% of cancer-related costs are attributable to pharmaceuticals. But these medicines have significantly improved quality and length of life and contributed to a stronger understanding of complex cancers. This continual progress leads to us closer to future new treatments and, hopefully, cures.
The authors express concerns about the out-of-pocket costs for patients. We share that concern; the purpose of insurance is to spread the risk of a substantial loss over a large insured population so that sick patients are not burdened with inordinately high costs for life-saving or life-improving treatment. However, in contrast to other aspects of patient care, cancer medicines are often subject to greater cost-sharing. As one response to this disproportionate cost-sharing, biopharmaceutical companies offer patient assistance programs and support the Partnership for Prescription Assistance (PPA), which has helped nearly 8 million people to date.
The authors also inaccurately characterize the differences in pricing across countries. While they do exist, cross national price differentials are not as large as alleged and remain roughly in line with differences in per capita income. Another issue the authors misrepresent is patent settlements, which can benefit patients by bringing generics to market before the patents for brand-name medication expire.
Making centralized decisions about the average value of a new treatment at launch would have a chilling effect on innovation and physicians’ abilities to customize care for individual patients. A case in point: the UK’s National Institute for Health and Clinical Excellence (NICE) applied its cost effectiveness analysis and recommended restricting access to the CML treatment Gleevec, blocking access for many patients with this condition. Under pressure, NICE eventually reversed its initial recommendation, but it serves as an example of how such policies can conflict with patients’ needs.
Policies like that used in the UK fail to recognize that progress does not happen with one breakthrough, but rather incremental stepping stones. Each new cancer medicine, whether it extends a life by six months or three years, reflects the cumulative nature of medical discovery. In addition, as each new medicine is used in the real world – earlier in the disease stage and in combination with other medicines – its full value is realized. This step-by-step transformation has led to increased survival, improved patient outcomes, and enhanced quality of life for CML patients and many other cancer patients.
As the study’s authors point out, CML is no longer a death sentence for most patients. In fact, they have close to normal life expectancy. This progress would not have been possible without a substantial investment in drug development. We need thoughtful policies that support continued innovation and promote access and affordability for patients.