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Doctors have long worried about the unintended consequences of cancer treatments. The unpleasant reactions to chemotherapy, for instance, are well-known — hair loss, nausea, vomiting and fatigue. Now physicians warn of another side effect: “financial toxicity”.
This is a recognition that the soaring price of drugs has become one of the main barriers to effective treatment. Under private healthcare systems, as in the US, families can face economic ruin. With publicly-funded medicines, as in the UK, they can be rationed or altogether blocked.
Enthusiasm over a new generation of promising therapies has been tempered by fears that they may be ultimately unaffordable, especially as they are made available to more patients. “There are 7,000 drugs in human testing in the US and a quarter of them are for cancer,” says Dr Steve Miller, chief medical officer of Express Scripts, one of the largest US buyers of prescription medicine. “We’ve never had that many in my 35 years in healthcare and the price points the companies are coming out with are unbelievable,” he adds.
At last year’s gathering of the American Society of Clinical Oncologists (Asco), doctors confronted the price question: “These drugs cost too much,” said Dr Leonard Saltz, a veteran oncologist. His statement raised eyebrows given that the forum has usually focused on science, not business.
According to Asco’s president, Dr Julie Vose, it has now given itself a remit to consider whether new medicines are good value. “We have to think about fairness, value and the financial toxicity issue,” she says. The new generation of immunotherapies, which can turn the body’s immune system into a weapon against cancer, are commanding prices in excess of $100,000 per year.
Annual price tag of Opdivo from Bristol-Myers Squibb
The drug Opdivo, from Bristol-Myers Squibb, has an annual price tag of $143,000. A US patient on a healthcare plan with a 20 per cent “copay” would have to find $28,600. Doctors say such a financial undertaking can force patients to make bad choices, such as buying poor quality food or working extra jobs — at the very moment they need to eat healthily and manage stress. For others, it is simply unaffordable.
Given that patients are often given several different drugs in a year, Dr Miller says in the future the average patient could receive medicines costing more than $250,000 per annum. One irony is that as cancer drugs become more effective, companies may have to lower rather than raise prices. In the past, cancer drugs have been priced for very ill patients, many of whom will only survive for weeks on a drug before dying. As such, drugmakers have had to try to recoup their cost and generate a profit over a much shorter period of time compared with a chronic disease, such as diabetes, where a patient can live with the illness for many years.
Possible future cost of medicines received each year by patients
Some of the latest cancer drugs have shown they can keep patients alive for years, hence drugmakers have a longer period over which to generate a profit. It also means that for cash-strapped health systems the cost of treating cancer patients has the potential to grow fast. “Cancer is becoming a chronic disease that could require more complex, costly and long-term treatment,” says a recent Express Scripts report.
Pharma companies are thinking about new models. For instance, they could receive a single fee for treating a sufferer, rather than charging for individual medicines. The fees could be tied to how well the patient responds. Such pricing would benefit companies that make a broad range of cancer drugs, allowing them to offer a variety of treatment options, says Liz Barrett, president of Pfizer’s oncology division. “We are in a unique position because we own a number of products, allowing us to think creatively,” she notes.
Doctors hope the overall cost of new cancer drugs could be contained by ensuring they are only given to patients most likely to benefit — a concept known as “personalised” or “precision” medicine. Many of the new cancer drugs are intended to be used with “diagnostic tests”, which allow forecasts on whether a drug is likely to work.