Interesting article about the cost of cancer treatment
Cost of cancer drugs crushes all but hope
Genentech reported a 61% rise in quarterly profit on strong sales of its cancer drugs in April 2005. Genentech's Avastin, Herceptin, Rituxan from $3,000 to $13,000.
VARIOUS TREATMENTS, COSTS
Some doctors and patients are concerned about the price of new cancer therapies.
Drug Company Monthly cost
Avastin Genentech $4,400
Erbitux ImClone/Bristol-Myers $10,000
Gleevec Novartis $2,600
Herceptin Genentech $3,000
Nexavar Bayer Pharmaceuticals $4,300
Revlimid Celgene $4,500
Rituxan Genentech $4,200 to $13,000 1
Sutent Pfizer $4,000
Tarceva Genentech/OSI Pharmaceuticals $2,400 to $2,700
Sources: manufacturers
By Liz Szabo, USA TODAY
When Tom Reek was diagnosed with a rare leukemia at age 65, doctors said he might live only another three years. Today, Reek is thriving at age 72, thanks to a drug called Gleevec.
"I used to kid around and say that I feel like Clark Kent," says Reek, who lives on Long Island, N.Y., and volunteers as a peer counselor with other patients, including youngsters. "It's like a gift from God to be able to work with these children."
The only downside to Gleevec, Reek says, is the cost: $3,100 a month. Reek went back to work four years ago as a truck driver, delivering blood tests and lab results to medical offices. With insurance, his pills cost only about $50 a month.
Since Gleevec was approved in 2001, researchers have hoped that every new cancer therapy would copy its success: a convenient pill that lets patients live for years with relatively few serious side effects. Though experts say few of the new "targeted" therapies come close to that ideal, they do have one thing in common with Gleevec: They're all incredibly expensive.
Some doctors are questioning whether targeted therapies designed to turn cancer into a chronic disease by silencing growth signals inside malignant cells are worth the expense to individuals and taxpayers.
Most new cancer drugs improve survival by only a few weeks or months, says researcher Leonard Saltz of New York's Memorial Sloan-Kettering Cancer Center. Although Erbitux, for example, costs almost $10,000 a month, studies have not shown that it helps colorectal cancer patients live longer.
"There is a real question whether insurance ought to pay for a drug like that," says Ezekial Emanuel, chairman of clinical bioethics at the National Institutes of Health clinical center. "If you pay for something that doesn't have a big impact, you could lose out on treatments that really do work.
"We can cure testicular cancer. We can cure Hodgkin's disease. You don't want to skimp on that."
Canada has decided that Erbitux isn't worth the money. Last month, Bristol-Myers Squibb Canada announced that it won't sell Erbitux there because it couldn't get "an appropriate price for its product reflecting the value of the innovation it brings."
Today's prices seem especially high, given that the new targeted therapies don't actually cure cancer, says Jerome Kassirer, former editor of The New England Journal of Medicine and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health
"Families could end up spending their fortunes for what turns out to be a minor benefit," Kassirer says.
As the number of targeted therapies increase, more patients are facing this decision. Almost 200,000 patients could soon be eligible for the drug Avastin if it's approved for lung and breast cancers, two of the most common malignancies, according to Genentech.
David Johnson, former president of the American Society of Clinical Oncology, says a few of his patients are turning down care because of the cost. Johnson, who has treated cancer for 25 years, notes, "That never used to happen."
All those years in medicine, though, also have made Johnson optimistic about targeted therapies, in spite of their high prices. A handful of his lung cancer patients have done remarkably well on Tarceva, he says, although patients overall live only two months longer than those on placebos.
"Some folks tend to hype any therapy that is new," Johnson says. "Reality always tends to center us."
Although he is glad new cancer drugs are available, Saltz says, doctors had hoped that targeted drugs would replace chemotherapy, making cancer treatment gentler.
But unlike Gleevec, many of the new drugs work only when combined with chemo, he says. Adding drugs such as Erbitux and Avastin to older therapies increases costs as well as side effects.
Patients today still don't live very long on most of the new medications. Survival for patients with advanced colon cancer has increased from one year to about two years over the past decade, Saltz says. Patients with only two years to live may see that as major progress, he says.
"The drug companies have been trying to put the word 'breakthrough' in my mouth since 1995," Saltz says. "But it's far too flattering to say we've made significant progress. ... The vast majority of targeted drugs are a long way from what we hoped they would be."
Industry leaders defend their prices. Officials from Bristol-Myers Squibb Co., which sells Erbitux, note that patents offer companies a limited amount of time to recoup their investments.
Tony Plohoros, a company spokesman, says the company respects the decisions of patients who opt not to use Erbitux. "That is a personal decision up to each individual patient and their loved ones," Plohoros says.
Administrators at public hospitals with limited budgets, such as Atlanta's Grady Hospital, have to make hard choices, says Otis Brawley, director of Grady Health System's Georgia Cancer Center for Excellence. Grady doctors also are considering limiting the use of Erbitux, Brawley says.
"We are constantly asking ourselves: Are we buying drugs that we really ought not to be buying?" says Brawley, a professor at Atlanta's Emory School of Medicine. "Are we going to bankrupt ourselves buying Avastin so we won't be around to treat other people?"
Comments
-
oh my dear sweet Lord- I hate to see a price put on peoples lives..governments probably spend more on roads...I can only hope that decision makers who determine what drugs are approved will have someone close to them be hit by cancer and then see how fast "expensive" therapies will be approved...
In Canada..even if you have the money..you can't buy erbitux..it is criminal!!...
Bev0 -
I saw the article this morning as I passed the USA Today stand. Thanks for sharing it with us Rodney.
I felt the same way as I read the headline - UNFREAKIN' BELIEVABLE! A few things to bear in mind, though (and, yes, I am going to play the devil's advocate and speak the pharmaceutical companies' position here:
Producing the pills doesn't cost all that much, but the years of research and development that go into the pills costs millions. they need to recoup their capital investment.
They can patent the drugs, but those patents usually run out after (if there's an attorney in the house correct me) 17 years, after which, it's a free for all.
Remember, just because something is patented doesn't keep everyone from getting it and reverse-engineering it so that it can be sold cheaper on the black market. That market cuts significantly into the sales of the legitimate product.
And let's not forget about our insanely letigious society here. If a drug causes a rare yet devistating side-effect (think Vioxx) what's the first thing we do? Go after those deep corporate pockets and try to get millions from the manufacturer. Thta's another cost that has to be factored into these meds.
It's the lure of these profits that keep pharmaceutical companies working on new meds despite the tripping hazards I just described. Take away the profits and you take away the incentive. Let's face it, Eli Lilly isn't in the business of making drugs because they want to make everyone feel better; they're in business for the same reason WalMart is in business; to make a profit. Don't misunderstand what I'm saying; I am certain that there are scores of people who work for these companies who are driven by a deep dedication to their customers and really do go to work every day with the idealistic notion that this will be the eureka day that they discover a panacea. But they are not the company; they are only part of it. Would it be worth the lawsuits, the millions of dollars and years of time invested in research & development, the constant fending-off of those generic drugs, etc. if we remove the profit incentive? probably not. In the end, where would that get us? Stuck with the meds we have now and nothing new in the works. business runs on the dollar, not on warm fuzzy feelings. Cold, but true. Don't let any Wall Street spin doctor or marketing exec fool you into thinking otherwise.
Another reason to think about socialized medicine? maybe... Another reason to juice? YOUBETCHA!
OK, off my soapbox now. Peace-out!
- SpongeBob0 -
Rodney - that's interesting.spongebob said:I saw the article this morning as I passed the USA Today stand. Thanks for sharing it with us Rodney.
I felt the same way as I read the headline - UNFREAKIN' BELIEVABLE! A few things to bear in mind, though (and, yes, I am going to play the devil's advocate and speak the pharmaceutical companies' position here:
Producing the pills doesn't cost all that much, but the years of research and development that go into the pills costs millions. they need to recoup their capital investment.
They can patent the drugs, but those patents usually run out after (if there's an attorney in the house correct me) 17 years, after which, it's a free for all.
Remember, just because something is patented doesn't keep everyone from getting it and reverse-engineering it so that it can be sold cheaper on the black market. That market cuts significantly into the sales of the legitimate product.
And let's not forget about our insanely letigious society here. If a drug causes a rare yet devistating side-effect (think Vioxx) what's the first thing we do? Go after those deep corporate pockets and try to get millions from the manufacturer. Thta's another cost that has to be factored into these meds.
It's the lure of these profits that keep pharmaceutical companies working on new meds despite the tripping hazards I just described. Take away the profits and you take away the incentive. Let's face it, Eli Lilly isn't in the business of making drugs because they want to make everyone feel better; they're in business for the same reason WalMart is in business; to make a profit. Don't misunderstand what I'm saying; I am certain that there are scores of people who work for these companies who are driven by a deep dedication to their customers and really do go to work every day with the idealistic notion that this will be the eureka day that they discover a panacea. But they are not the company; they are only part of it. Would it be worth the lawsuits, the millions of dollars and years of time invested in research & development, the constant fending-off of those generic drugs, etc. if we remove the profit incentive? probably not. In the end, where would that get us? Stuck with the meds we have now and nothing new in the works. business runs on the dollar, not on warm fuzzy feelings. Cold, but true. Don't let any Wall Street spin doctor or marketing exec fool you into thinking otherwise.
Another reason to think about socialized medicine? maybe... Another reason to juice? YOUBETCHA!
OK, off my soapbox now. Peace-out!
- SpongeBob
I agree with Bob and all that it is pretty unbelievable. But - not really trying to be a devil'sadvocate - I can understand why pharmaceutical companies are charging to recoup their costs. My biggest concern, however, that none of you have addressed so far, is the the THREAT that insurance companies / gov't insurance might stop paying for these targeted treatments. I thought we were all about not believing in statistics - stats do NOT apply to any one individual, right? So the threat of a targeted drug NOT being paid for by insurance because the stats are not outstanding is a real THREAT to me! Who cares about the stats? I am NED today and a year ago at diagnosis - had I asked (which I did not) - my oncologist would have probably told me I had one-two years. Now - who knows? But without Avastin, I might not be in this "happy" place. Point is - let's hope the stats don't drive medical care, cuz if they do, lots of us will be doomed.
Take care all,
Betsy0 -
You devil you!!!!!spongebob said:I saw the article this morning as I passed the USA Today stand. Thanks for sharing it with us Rodney.
I felt the same way as I read the headline - UNFREAKIN' BELIEVABLE! A few things to bear in mind, though (and, yes, I am going to play the devil's advocate and speak the pharmaceutical companies' position here:
Producing the pills doesn't cost all that much, but the years of research and development that go into the pills costs millions. they need to recoup their capital investment.
They can patent the drugs, but those patents usually run out after (if there's an attorney in the house correct me) 17 years, after which, it's a free for all.
Remember, just because something is patented doesn't keep everyone from getting it and reverse-engineering it so that it can be sold cheaper on the black market. That market cuts significantly into the sales of the legitimate product.
And let's not forget about our insanely letigious society here. If a drug causes a rare yet devistating side-effect (think Vioxx) what's the first thing we do? Go after those deep corporate pockets and try to get millions from the manufacturer. Thta's another cost that has to be factored into these meds.
It's the lure of these profits that keep pharmaceutical companies working on new meds despite the tripping hazards I just described. Take away the profits and you take away the incentive. Let's face it, Eli Lilly isn't in the business of making drugs because they want to make everyone feel better; they're in business for the same reason WalMart is in business; to make a profit. Don't misunderstand what I'm saying; I am certain that there are scores of people who work for these companies who are driven by a deep dedication to their customers and really do go to work every day with the idealistic notion that this will be the eureka day that they discover a panacea. But they are not the company; they are only part of it. Would it be worth the lawsuits, the millions of dollars and years of time invested in research & development, the constant fending-off of those generic drugs, etc. if we remove the profit incentive? probably not. In the end, where would that get us? Stuck with the meds we have now and nothing new in the works. business runs on the dollar, not on warm fuzzy feelings. Cold, but true. Don't let any Wall Street spin doctor or marketing exec fool you into thinking otherwise.
Another reason to think about socialized medicine? maybe... Another reason to juice? YOUBETCHA!
OK, off my soapbox now. Peace-out!
- SpongeBob
But, you know I've got to come back at you.
I am not sure of the timelines of the whole competition/generic drug stuff but I do know they are quaranteed 5-7 years of NO competition to recoup their "expenses" and they do that quite well.
I really liked your black market one. I think I will google Avastin so I can run out and buy it on the internet and hope like hell the infusion center will use it. Chemo drugs are safe from that so far. The only time drugs can be bought on the black market is if it is done on the internet or on the street corner, you have to be careful. I only get about 20 emails a week for erectile dyfunction prescription drugs, I wonder how many are legit?
I agree about it being a business and businesses need to have profitable revenue to survive. BUT, there are ethical ways to do it and in my opinion, unethical ways to do it. A very healthy profit margin for any business is 4-5% (all expenses are subtracted from all revenue to show total profit margin. That includes lawsuits, advertising, TV commercials, salaries, taxes, fees, parties, every expense!!!!!). A profit margin of 7-9% is wonderful, but usually short lived due to novelty ideas that others learn to compete with eventually and that drives down prices, then the profits unless you can release another product in a very timely manner. If you do some research you will find that for the last 10 years the companies that have consistantly had over 10% profit margins are oil, pharmaceutical companies and a few banks. I consider that to be gross and should be considered taking advantage of people. Oh, and I almost forgot to mention the marketing and advertising expenses (yes all those durn TV commercials), are over a billion dollars a year and GROWING!!!!!!!
For the life of me I can't understand why Oxiliplatin costs %15,000 per dose in the US, but France only pays $500.00 per dose for it. As the CEO of Phizer said so eloquently on 60 Minutes; "In the US, we charge what the market will bear", but what he did not say was he knew that desperate people in desperate situations will pay lots of money because our current system allows them to.
I also understand Betsy's concerns, but she misread that part. Atlanta's Grady Hospital is one of many hospitals in the US that are "public" hospitals (not private) that are state supported and absorb the costs of service to people with no insurance. That is why they have to be really careful. Trust me, your insurance company will never stop paying for chemo drugs unless loads of people die from them. Remember, they pay for Type II Diabetes patients "stuff" and many other illnesses when they are completely reversible with diet and exercise, so I wouldn't worry about that. Your and your employer's health insurance rates will just go higher, all part of the fast growing cost of health care.
An interesting tidbit on my costs to date. My insurance company and I have paid more the approximately $600,000 for my cancer "stuff" thus far (that does not include disability pay and other company related benefits). Of that, drugs/medications costs are $390,000 alone.
I think I also get angry that we don't have a single place to learn all we need to for fighting this **** while ultimately preventing it. Out docs can't take all the courses to learn any more then they already have to. We desperately need for the "Eastern and the Western Medical Approaches" to join forces and put some sanity back into our health care. I want wellness and healing, not just drugs for life!!!!!!!!
Lisa P.0 -
One reason this article caught my eye was the reference to Grady Hospital. When I was first diagnosed, I was working a part time job at Coca-Cola while taking some classes at Georgia State University to get into a graduate program. So then cancer came along, and my very limited part time job health insurance plan paid a modest percentage of the colonoscopy cost and my colectomy. Then ... I was on my own, essentially uninsured and already with a big debt. I applied for, and got, government assistance in the form of Dekalb county Medicaid. Keeping that active has not been graceful. Since February I have been without coverage and watching to "TOTAL" box on my medical expenses spread sheet get larger and larger, although I have a new application for assistance that has been pending since late January. I get my infusions at Northside Hospital, and I know that they will write off the cost if worst comes to worst, because I filled out a financial aid form. I love them for that! The only reason I am getting my infusions at Northside was because when I started getting treatment I lived closer to Northside. Now I live closer to Grady, but I plan to stay with Northside. So far they have been very helpful.scouty said:You devil you!!!!!
But, you know I've got to come back at you.
I am not sure of the timelines of the whole competition/generic drug stuff but I do know they are quaranteed 5-7 years of NO competition to recoup their "expenses" and they do that quite well.
I really liked your black market one. I think I will google Avastin so I can run out and buy it on the internet and hope like hell the infusion center will use it. Chemo drugs are safe from that so far. The only time drugs can be bought on the black market is if it is done on the internet or on the street corner, you have to be careful. I only get about 20 emails a week for erectile dyfunction prescription drugs, I wonder how many are legit?
I agree about it being a business and businesses need to have profitable revenue to survive. BUT, there are ethical ways to do it and in my opinion, unethical ways to do it. A very healthy profit margin for any business is 4-5% (all expenses are subtracted from all revenue to show total profit margin. That includes lawsuits, advertising, TV commercials, salaries, taxes, fees, parties, every expense!!!!!). A profit margin of 7-9% is wonderful, but usually short lived due to novelty ideas that others learn to compete with eventually and that drives down prices, then the profits unless you can release another product in a very timely manner. If you do some research you will find that for the last 10 years the companies that have consistantly had over 10% profit margins are oil, pharmaceutical companies and a few banks. I consider that to be gross and should be considered taking advantage of people. Oh, and I almost forgot to mention the marketing and advertising expenses (yes all those durn TV commercials), are over a billion dollars a year and GROWING!!!!!!!
For the life of me I can't understand why Oxiliplatin costs %15,000 per dose in the US, but France only pays $500.00 per dose for it. As the CEO of Phizer said so eloquently on 60 Minutes; "In the US, we charge what the market will bear", but what he did not say was he knew that desperate people in desperate situations will pay lots of money because our current system allows them to.
I also understand Betsy's concerns, but she misread that part. Atlanta's Grady Hospital is one of many hospitals in the US that are "public" hospitals (not private) that are state supported and absorb the costs of service to people with no insurance. That is why they have to be really careful. Trust me, your insurance company will never stop paying for chemo drugs unless loads of people die from them. Remember, they pay for Type II Diabetes patients "stuff" and many other illnesses when they are completely reversible with diet and exercise, so I wouldn't worry about that. Your and your employer's health insurance rates will just go higher, all part of the fast growing cost of health care.
An interesting tidbit on my costs to date. My insurance company and I have paid more the approximately $600,000 for my cancer "stuff" thus far (that does not include disability pay and other company related benefits). Of that, drugs/medications costs are $390,000 alone.
I think I also get angry that we don't have a single place to learn all we need to for fighting this **** while ultimately preventing it. Out docs can't take all the courses to learn any more then they already have to. We desperately need for the "Eastern and the Western Medical Approaches" to join forces and put some sanity back into our health care. I want wellness and healing, not just drugs for life!!!!!!!!
Lisa P.
In order to keep any form of government assistance with Medicaid, I cannot earn more than $65 monthly (yes, $65, that's not a misprint!). So basically ... I'm not allowed to work. But I REALLY want to work again, but if I get a job then I lose any chance of Medicaid being reinstated and I won't qualify for assistance from the hospital so I will either have to pay for treatment as I go along (which isn't possible) or not get treated at all (i.e. wait to die), and a private health insurance plan with an employer almost certainly will not conver cancer costs for a year or maybe more. Does anyone know if there is a way around this complication? Surely someone, somewhere, has transitioned from Medicaid to full employment while getting some form of treatment. Or am I the first? (maybe it's never been done because it was never possible before and it is only possible now due to my use of targeted therapy?) I am VERY eager to work again and not have to rely on "the system" so any advice would be great.
Rodney0 -
Hi Rodney,rthornton said:One reason this article caught my eye was the reference to Grady Hospital. When I was first diagnosed, I was working a part time job at Coca-Cola while taking some classes at Georgia State University to get into a graduate program. So then cancer came along, and my very limited part time job health insurance plan paid a modest percentage of the colonoscopy cost and my colectomy. Then ... I was on my own, essentially uninsured and already with a big debt. I applied for, and got, government assistance in the form of Dekalb county Medicaid. Keeping that active has not been graceful. Since February I have been without coverage and watching to "TOTAL" box on my medical expenses spread sheet get larger and larger, although I have a new application for assistance that has been pending since late January. I get my infusions at Northside Hospital, and I know that they will write off the cost if worst comes to worst, because I filled out a financial aid form. I love them for that! The only reason I am getting my infusions at Northside was because when I started getting treatment I lived closer to Northside. Now I live closer to Grady, but I plan to stay with Northside. So far they have been very helpful.
In order to keep any form of government assistance with Medicaid, I cannot earn more than $65 monthly (yes, $65, that's not a misprint!). So basically ... I'm not allowed to work. But I REALLY want to work again, but if I get a job then I lose any chance of Medicaid being reinstated and I won't qualify for assistance from the hospital so I will either have to pay for treatment as I go along (which isn't possible) or not get treated at all (i.e. wait to die), and a private health insurance plan with an employer almost certainly will not conver cancer costs for a year or maybe more. Does anyone know if there is a way around this complication? Surely someone, somewhere, has transitioned from Medicaid to full employment while getting some form of treatment. Or am I the first? (maybe it's never been done because it was never possible before and it is only possible now due to my use of targeted therapy?) I am VERY eager to work again and not have to rely on "the system" so any advice would be great.
Rodney
All I know is the public hospitals can not refuse service to anyone. I think that is what all the hoopla about illegal immigrants raising health care costs is all about. I would ask Northside for their advice on your options. Over half of my large family is in the medical business and all of them say, no one should do without health care, you just have to ask and work at it. What may usually be a 1 hr appt. may end up taking you a whole day but you still get treated.
I hope this helps.
Lisa P.0 -
Hey, Rodney -rthornton said:One reason this article caught my eye was the reference to Grady Hospital. When I was first diagnosed, I was working a part time job at Coca-Cola while taking some classes at Georgia State University to get into a graduate program. So then cancer came along, and my very limited part time job health insurance plan paid a modest percentage of the colonoscopy cost and my colectomy. Then ... I was on my own, essentially uninsured and already with a big debt. I applied for, and got, government assistance in the form of Dekalb county Medicaid. Keeping that active has not been graceful. Since February I have been without coverage and watching to "TOTAL" box on my medical expenses spread sheet get larger and larger, although I have a new application for assistance that has been pending since late January. I get my infusions at Northside Hospital, and I know that they will write off the cost if worst comes to worst, because I filled out a financial aid form. I love them for that! The only reason I am getting my infusions at Northside was because when I started getting treatment I lived closer to Northside. Now I live closer to Grady, but I plan to stay with Northside. So far they have been very helpful.
In order to keep any form of government assistance with Medicaid, I cannot earn more than $65 monthly (yes, $65, that's not a misprint!). So basically ... I'm not allowed to work. But I REALLY want to work again, but if I get a job then I lose any chance of Medicaid being reinstated and I won't qualify for assistance from the hospital so I will either have to pay for treatment as I go along (which isn't possible) or not get treated at all (i.e. wait to die), and a private health insurance plan with an employer almost certainly will not conver cancer costs for a year or maybe more. Does anyone know if there is a way around this complication? Surely someone, somewhere, has transitioned from Medicaid to full employment while getting some form of treatment. Or am I the first? (maybe it's never been done because it was never possible before and it is only possible now due to my use of targeted therapy?) I am VERY eager to work again and not have to rely on "the system" so any advice would be great.
Rodney
maybe you can con Scouty into being your "sugar mamma"!0
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