[Ip-health] Andrew Pollack in the NYT: Cancer Doctors Offer Way to Compare Medicines, Including by Cost

Jamie Love james.love at keionline.org
Mon Jun 22 18:52:19 PDT 2015


As the US begins to think about drug prices, what policies will be
available when prices are too high?  The TPP seeks to limit the options.

Jamie

------------
* Alarmed by the rapid escalation in the price of cancer drugs, the
nation’s leading oncology society unveiled on Monday a new way for doctors
and patients to evaluate different treatments — one that pointedly includes
a medicine’s cost as well as its effectiveness and side effects.


* He said the price of new cancer drugs now averaged about $10,000 a month,
and some cost $30,000 a month, which can mean prohibitive co-payments even
for some patients with good insurance. "Many cancer patients are facing
severe financial strain, even bankruptcy in some cases," he said.

* Eli Lilly’s Alimta for that same use had a net heath benefit of zero with
a cost exceeding $9,000 a month compared to about $800 a month for the
drugs it was compared to in the clinical trial.


http://www.nytimes.com/2015/06/23/business/cancer-doctors-offer-way-to-compare-medicines-including-by-cost.html

Cancer Doctors Offer Way to Compare Medicines, Including by Cost
By ANDREW POLLACK
JUNE 22, 2015

Alarmed by the rapid escalation in the price of cancer drugs, the nation’s
leading oncology society unveiled on Monday a new way for doctors and
patients to evaluate different treatments — one that pointedly includes a
medicine’s cost as well as its effectiveness and side effects.

The release by the American Society of Clinical Oncology of what it calls
its "value framework," is part of a change in thinking among doctors, who
once largely chose drugs based on their medical attributes alone. The major
cardiology societies, for instance, are also now starting to factor cost
into their evaluation of drugs.

"The reality is that many patients don’t get this information from their
doctors and many doctors don’t have the information they need to talk with
their patients about costs," Dr. Richard Schilsky, chief medical officer of
the oncology society, said in a news conference on Monday.

He said the price of new cancer drugs now averaged about $10,000 a month,
and some cost $30,000 a month, which can mean prohibitive co-payments even
for some patients with good insurance. "Many cancer patients are facing
severe financial strain, even bankruptcy in some cases," he said.

The value framework envisions considering two costs: the out-of-pocket
costs for the patient and the overall cost of a drug to the health system.

Evaluating the latter cost would put doctors in the role of being stewards
of societal resources. That is somewhat of a controversial role for
doctors, since it might conflict with their duty to the patient in front of
them. But the oncology society said it did not see those roles as being in
conflict.

Some of the sample valuations presented by the society were far from
flattering for the drugs involved.

Roche’s Avastin, when added to chemotherapy, had a net health benefit of 16
out of 130 possible points when used as an initial treatment for advanced
lung cancer. Its monthly cost was $11,907.87, compared to $182.09 for the
chemotherapy alone.

Eli Lilly’s Alimta for that same use had a net heath benefit of zero with a
cost exceeding $9,000 a month compared to about $800 a month for the drugs
it was compared to in the clinical trial.

A spokeswoman for Lilly said the trial analyzed by the oncology society
understated Alimta’s effectiveness because it covered a broad population,
whereas Alimta is approved for only one type of lung cancer. A spokeswoman
for Roche said Avastin was the first drug to help lung cancer patients live
longer than a year, and that the choice of treatments for life-threatening
diseases was complex and personal.

The framework, published online Monday by The Journal of Clinical Oncology
is more a proposed methodology that will now be open for public comment. It
will take time to input the data on the effectiveness, side effects and
costs of each drug, and convert it to a system that can be used on
computers and mobile phones.

There is no requirement that doctors use the framework and it remains to be
seen if they will. But the authors of the document say it is a start.

"It allows the patient and the doctor to at least talk through the issues,"
said Dr. Lee N. Newcomer, senior vice president for oncology at
UnitedHealthcare, the big insurance company, and a member of the task force
that developed the framework. "Before, the information wasn’t there."

UnitedHealthcare is mounting a similar effort of its own, Dr. Newcomer
said. Starting this month, it is requiring oncologists to get prior
approval from the insurance company for every cancer drug they administer.
The company will then track what happens to patients and eventually provide
information to doctors about how well each drug works.

Concern about cancer drug prices has been rising for years and doctors have
been becoming increasingly vocal. At its annual meeting late last month,
the oncology society included a talk sharply criticizing the prices of
cancer drugs as part of its plenary session.

Randy Burkholder, vice president for policy and research at the
Pharmaceutical Research and Manufacturers of America, the drug industry
trade group, said that drugs represented only 20 percent of cancer
treatment costs. He also said that the big clinical trials that the
oncology society used to make its value calculations might not be as
relevant as treatment becomes increasingly personalized based on genetic
analysis of a patient’s tumor.

Some experts say that ideally, the price of a drug should reflect its
value, but that does not seem to be the case with cancer drugs. A recent
study by researchers from the National Cancer Institute, published in JAMA
Oncology, surveyed cancer drugs approved from 2009 through 2013. It found
that prices did not correlate very well with how novel a drug was or
whether it prolonged life versus just shrinking tumors.

The framework computes a score — called the net health benefit — based on
clinical trial data.

Drugs for advanced cancer are given a score from 0 to 130. Up to 80 of the
points are based on a drug’s effectiveness in prolonging lives, delaying
the worsening of cancer or shrinking tumors. Then up to 20 points can be
added or subtracted based on side effects. And up to 30 bonus points can be
granted if the drug relieves cancer symptoms or allows a patient to go
without treatment for a period of time.

The costs of the drug are listed separately, rather than incorporated into
the final score for a drug. That is a step short of what is done in some
evaluations, such as those by the National Institute for Health and Care
Excellence in Britain, in which drugs are rated by the cost per extra year
of life they provide, adjusted by side effects and symptoms.

Researchers at Memorial Sloan Kettering Cancer Center recently announced a
tool that allows people to evaluate the cost-effectiveness of cancer drugs.

These other institutions "take the next step to say ‘What do we think about
this amount of benefit at this cost?’" said Dr. Steven D. Pearson,
president of the Institute for Clinical and Economic Review, a nonprofit
organization that evaluates the clinical and cost effectiveness of
treatments.

Dr. Lowell E. Schnipper, chairman of the task force that developed the
oncology society’s framework, said that patients wanted to know how
medically effective a drug is. Adding the cost into an overall rating would
obscure that information, he said.

Each drug is evaluated based on how it did in clinical trials compared to a
control group, and the control groups can be different. That makes it
difficult to compare one drug to another.

"This is not a way of ranking drugs," said Dr. Schnipper, who is clinical
director of the cancer center at Beth Israel Deaconess Medical Center in
Boston. "This is simply a way of understanding the outcome of a clinical
trial."


-- 
James Love.  Knowledge Ecology International
http://www.keionline.org/donate.html
KEI DC tel: +1.202.332.2670, US Mobile: +1.202.361.3040, Geneva Mobile:
+41.76.413.6584, twitter.com/jamie_love



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