Tuesday, October 23, 2012

Cost of Drugs

In a recent paper by Siddiqui and Rajkumar the authors detail the costs of some of the recent cancer drugs[1]. They state:


Last year, ipilimumab (Yervoy; Bristol-Myers Squibb, New York, NY) was approved by the Food and Drug Administration (FDA) for the treatment of metastatic melanoma. The benefit in survival over and above standard treatment arms was 3.7 months in previously treated patients and 2.1 months in previously untreated patients. The cost: $120,000 for 4 doses. As staggering a figure as that is, the drug is hardly alone in its lofty price. We believe that the immense cost of contemporary cancer drugs signals even greater costs for future drugs.

The following Table is from their paper as modified. Note the annual costs. What are not presented are the survival rates, for example melanoma extends survival 4 months for $120,000. That is $30,000 per month.

Generic drug name
Cancer
Cumulative drug cost for 1 y ($)
Ipilimumab
Melanoma
120,000
Sipuleucel-T
Prostate cancer
90,000 for 3 doses
Bevacizumab
Various cancers, including lung and colon cancer
90,000
Paclitaxel, protein-bound
Breast cancer
80,000
Lenalidomide
Multiple myeloma
90,000
Bortezomib
Multiple myeloma
60,000
Imatinib mesylate
Chronic myeloid leukemia
70,000
Alemtuzumab
Chronic leukemias
70,000
Ofatumumab
Lymphomas and chronic lymphoid leukemias
120,000
Brentuximab vedotin
Hodgkin lymphoma
100,000
Dasatinib
Chronic myeloid leukemia
110,000

Now the authors proceed to argue why they are so expensive and argue as to what can be done to reduce costs. In a sense this is still health care research financed by the public and not really beneficial drug disbursement. Almost all of these drugs are at best minimal life prolongers. Perhaps we are at a very early stage where we use large populations to fund experimental protocols as well as drugs.