October 23rd, 2015 BY HealthNetwork
More than one hundred noted oncologists have suggested that the cost of cancer treatment drugs is unattainable for many patients in need of what can be life saving treatments. Claiming that the treatment cost of some of the newer cancer drugs is more than $100,000 dollars per treatment and that the patient’s out-of-pocket portion of the bill could be as much as twenty to thirty percent of that, $25,000 to $30,000 dollars per treatment, making the cancer drugs not affordable for most patients.
But, healthcare advocates point out that typical insurance policies have much lower out-of-pocket thresholds, for example the ACA (Affordable Care Act) exchange insurance policies have placed a set amount of $6,600 dollars for an individual’s out-of-pocket expense and $13,200 dollars for a family. Likewise, Medicare Part D’s Catastrophic Coverage has a provision for such treatments with a threshold of $4,700 dollars after which the patient would pay 5 percent of the cancer drugs costs. As for employer provided health insurance most large employer based plans also have maximum out-of-pocket limits that are in keeping with the ACA and Medicare’s limits.
It also should be noted that drug manufacturers typically have assistance programs to aid people who cannot afford their medications and that most hospitals and insurance companies negotiate drug prices with the pharmaceutical companies to get substantial reductions from the retail price lists to reduce costs to the patients.
What Drives the Cost of Cancer Drugs so High?
There are numerous factors that drive up the costs of developing new drugs beginning with research and development or R&D as it is commonly called. It is impossible for researchers to know which drugs will be successful, both clinically and financially, it is more often numerous failures for every success and oncology drug research and development is typically more costly. It is estimated that the average cost of taking a new drug to market is about $2.6 billion dollars which includes the overhead costs of research and development of the numerous failures as well as the one success. Oncology drugs are even more challenging because the benefits to the patient are typically only partially successful and the monetary returns are limited at best.
Money Aside is the Real Cost of Cancer Treatment Worth it to Cancer Patients?
Putting aside the high cost of cancer drugs, healthcare experts in the field are looking at the clinical results as to how often oncologists are prescribing chemotherapy to patients whom receive little or no valuable improvement in stopping their cancer or improving the quality of their life. A 2012 American Society of Clinical Oncology (ASCO) panel called attention to the widespread use of chemotherapy in patients for which there was no evidence of clinical value. But even though there was no evidence to support the use of chemotherapy and the ASCO’s recommendations against using it, the panel found that chemotherapy is still widely used in advanced cancer patients with poor performance status. However, the ASCO does support treating cancer patients who do have good performance status.
But not all experts in the field agree, a JAMA Oncology study concluded that using chemotherapy in terminal cancer patients does not extend the life of the patients and that their quality of life (QOL) worsened whether they had poor or good performance status.
This is not to say that there are not new cancer treatments worth the expense and side effects experienced from taking them. One such treatment would be Imatinib (Gleevec) which has increased the five year survival rate from 31 percent to 90 percent in cancer patients with Chronic Myelogenous Leukemia. The cost for this new drug treatment ranges from $30,000 to $100,000 per year each year the patient survives. However, this is not the case for most solid cancer drug therapies and while the FDA approves new cancer drugs routinely they for the most part have little clinical benefit to the patient and in fact typically diminish the patient’s quality of life.
So, you may be asking why these oncologists routinely offer their terminal cancer patients successive rounds of chemotherapy that has little or no positive results for their patients. Doctors are often faced with the desperation of the patient and family members need to “try anything” to survive the cancer, but unless it is an experimental drug therapy research study, there is no logical reason an oncologist should prescribe these overly expensive and relatively ineffective drug therapies to their terminal patients. Neither the patient, nor their family members will benefit from false hope and a treatment plan that will only diminish their quality of life.
Over-prescribing New Chemotherapy Drugs Keeps the Prices Higher
Furthermore, it is precisely the over prescribing of these new chemotherapy drugs that helps to drive and maintain the high prescription costs. If oncologists stopped over-prescribing these expensive therapies that are of little value to the patients, the lack of sales would lower the market prices of these drugs to a more accurate cost in relation to what the drug actually accomplishes for the patient. One such instance of this occurring was with the drug Aflibercept (Zaltrap), when Sloan Kettering Cancer Center issued a statement saying it would no longer use the drug because it was no more effective than other alternative drugs of equal patient value and cost twice as much the drug manufacturer cited “market resistance” and lowered the price of the drug by fifty percent. More “market resistance” is needed in fight to lower drug costs across the board.