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Rise in cancer therapy costs 'unsustainable' says oncologist

Leonard Saltz made the claims in his keynote presentation at ASCO

Rare diseases orphan drugsWhile the clinical data coming out of ASCO was encouraging, a leading oncologist used the platform to launch a broadside at the high prices being charged for new cancer drugs.

Leonard Saltz of Memorial Sloan Kettering Cancer Centre (MSKCC) told delegates in a keynote presentation that cancer drug prices are not related to the value of the drug but are "based on what has come before and what the seller believes the market will bear."

In a presentation focusing mainly on immuno-oncology drugs, he pointed out that the much-lauded combination of Bristol-Myers Squibb's PD-1 inhibitor Opdivo (nivolumab) and anti–CTLA-4 antibody Yervoy (ipilimumab) in melanoma carries a regimen cost for a typical 80kg patient of nearly $300,000.

If all the US patients with metastatic cancer took a regimen set at that price, the total cost to the healthcare system would be an eye-watering $174bn, he pointed out.

"The price of ipilimumab is "approximately 4,000 times the cost of gold," said Saltz who indicated that while the efficacy of Opdivo/Yervoy was clear from the study, their value in terms of cost and associated benefits is still in question.

The rising costs of these drugs do not reflect development costs, nor do they help drive innovation, said Saltz, who noted that the median price of new cancer therapies in the US had doubled from $4,716 in 2000-2004 to $9,900 in 2010-2014.

He also outlined a hypothetical case in which Merck & Co's Keytruda (pembrolizumab) - given at a dose of 10mg/kg every two weeks to a 75kg patient - could cost $83,500 per month or more than $1m a year. Even at the lower dose of 2mg/kg the price would still be $16,700 per month using the model.

"The unsustainably high prices of cancer drugs is a big problem, and it's our problem," he told delegates at ASCO, suggesting there has to be some upper limit that society is prepared to pay to treat a cancer patient.

"It's a very unpleasant discussion. It's very uncomfortable," but it is a necessary one to have, he said.  

Like others such as US pharmacy benefit manager (PBM) Express Scripts, Saltz believes one solution to the problem might line in pay-for-performance (P4P) approaches, for example setting price on predetermined value targets or indication-specific pricing to take into account varying efficacy rates between cancer types.

He also mooted the idea of providing drugs free-of-charge for the first eight to 12 weeks of therapy to gauge whether they will have an impact.

Saltz has been a vocal critic of cancer drug pricing for some time, and was one of the architects of MSKCC's decision three years ago not to prescribe Zaltrap (ziv-aflibercept) to colorectal cancer patients on cost grounds. Zaltrap was also turned down by the UK's National Institute for Health and Care Excellence (NICE) and was recently de-listed from the Cancer Drugs Fund.

MSKCC reportedly took a similar line with Celgene's Abraxane (nab-paclitaxel), refusing to include it in the institution's formulary until its manufacturer agreed a price reduction that brought the cost into line with its benefits. 

He suggested the US might benefit from a NICE-style health technology assessment approach given that the FDA does not consider costs in its reviews and that the Centers for Medicare and Medicaid Services is unable to negotiate prices with drug companies.  

Article by
Phil Taylor

1st June 2015

From: Sales

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