Prasad spoke Wednesday in a Webinar offered by Breast Cancer Action, a California-based group that advocates for less toxic cancer treatments and a less toxic environment that contributes to cancer incidence. The group takes no money from drug companies. See the Webinar.
Some highlights and what this all means for you:
The cost of cancer drugs has risen far above the cost of inflation. Prasad noted that the cost of cancer treatment in 1975 was $129 per month. That would be about $600 today, adjusted for inflation. However, the average price of new cancer drugs today is about $10,000 per month. That is in line with the cost of Jakafi (ruxolitinib), which many ET patients take.
Cancer drug prices only somwhat reflect the benefits that cancer patients care about Most cancer patients, Prasad noted, care mostly about two things: 1. Will this drug cure me or extend my life? 2. Can I take this drug without significantly reducing my quality of life? Prices, he says, are only somewhat linked to those two questions. Many very expensive drugs may extend life only for a few months and with side-effects that some patients find unacceptable.
QALY figures can be misleading. QALY stands for "quality adjusted life year." It measures how long a drug can keep a patient with a particular disease in perfect health. (A QALY of 1 means that the drug will keep you in perfect health for a year.) But QALY studies are often problematic, said Prasad. For example, some studies are sponsored by the manufacturers, who have an interest in presenting doctors and patients with the "best case" outcomes of their drugs. In addition, sometimes younger-than-average patients are tested. These patients tolerate the drugs better than the average older patients, and skew drug test results. He gave the example of a liver cancer drug that showed a two month life expectancy increase in young patients. But among the majority of the patients with the cancer, who were older than the test group, there was no life expectancy increase. In addition, the side effects of the drug were so bad that most older patients said they would rather not take it.
Research and development (R&D) costs are far less than drug companies admit. Many pharmaceutical companies claim that the cost of bringing a drug to market is about $2.6 billion. However, the real cost of bringing a drug to market, according to Dr. Prasad, is far less, about $700 million. Moreover, most recently approved cancer drugs earn many times over their R&D costs within the first few years of approval. Jakafi is a relatively modest earner for manufacturer Incyte, having made only about twice drug's R&D in profits for the company.
There is room to reduce prices without stifling R&D incentives. Prasad said that pharmaceutical companies earn as much as 43 percent profit--(revenues after R&D, advertising, and manufacturing costs are factored in). This makes pharmaceuticals one of the most lucrative, least risky businesses, and this lack of risk reduces incentives to look for better drugs, Prasad argued.
How do we get better, cheaper drugs? If a drug company can make huge profits from a drug that adds only two months to a patient's life, why should it bother to go to the trouble to better drugs? Dr. Prasad said that a stricter FDA approval process that demands more significant benefits to patients might be one answer. Prasad noted that other measures that might reduce chemo prices would be to allow Medicare to bargain with drug companies for lower prices, and re-examining the Affordable Health Care caps on insurance company profits that stifle their incentives to bargain for lower prices.
Generic competitors for cancer drugs offers patients price relief. However, one of the problems in getting generic drugs to market is the fact that drug companies can maintain an exclusive patent on the drugs for about 20 years. So a drug developed today will not be eligible to go generic at least until 2038. The Orphan Drug Act of 1980 extends that patent beyond 20 years in many cases. Because ET is classified as an "orphan disease" (it affects fewer than 1 in 100,000 people), drugs developed through the ODA may be expensive for a much longer time.
Bottom line for you: A really good, basic question to ask your hematologist who prescribes a new drug for your ET is this: How will this drug help me? That is, how much will it improve my life expectancy? What will I have to put up with in the way of side effects to gain the benefits from the drug? If you don't get good answers to these questions, seek a second opinion.
Be well!
Related: Jakafi, oral chemo, and drug costs
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ET is a serious disease that requires specialist care. Discuss anything you read here with your doctor. No comments promoting "alternative" or "natural" cures (yes, this includes Rick Simpson's Oil) will be published.