This article was contributed by PharmARCians, and was first
published in www.pharmabiz.com.
BANGALORE, December 27, 2007- In the wake of the UK National Institute for
Health and Clinical Excellence's (NICE) decision to reject the new lug cancer
drug Tarceva (erlotinib) on grounds of its limited use over existing therapies
and higher cost of therapy, the cost effectiveness of ever increasing oncology
treatments, particularly the modern oncology treatments, has come under
scanner.
In 2004, national cancer treatment expenditure in the US stood at $72.1
billion, reflecting a growth rate of 6.4 per cent (CAGR, 1995-2004). This is a
little less than 5 per cent of overall spending for medical treatment in US.
Expenditure for the four most common cancers, i.e., lung, breast, colorectal
and prostate, constituted 47 per cent of total expenditure in 2004.
The situation is no different in India. Indian patients are at the receiving
end, where the cost of cancer therapy is soaring high. Cost comparison of a few
drugs for different cancer types would provide a clear picture of today's
cancer therapy trends in India. Increasing cost of therapy is of great concern
in the country, where almost 80 per cent of healthcare cost is of
out-of-pocket, which is borne by the households.
Cost of cancer therapy is dependent on many variables like mode of treatment,
line of therapy, stage of disease etc. Hence, increasing cost is attributed to
various factors.
The objective of cancer treatment is to kill the fast-multiplying cancer cells
in the shortest possible time. Hence, oncologists are always on the lookout for
the most effective and new drug that is available in the market, which can hit
hard and attack multiple pathways of tumour development. Targeted therapies are
the new class of anticancer drugs that act on multiple pathways to control
tumour growth. Trastuzumab is one such targeted therapy being increasingly used
in breast cancer, the cost of which is 6 times more as compared to the commonly
used regimen ACT.
To further strengthen the hands of oncologists, the research for newer and
novel cancer therapies is higher as compared to any other therapeutic area.
About 650 drugs are in various phases of development for cancer by
Pharmaceutical Research and Manufacturers of America (PhRMA) member companies
alone. The new drugs, even with marginal improvement in the survival rate, can
demand premium price and drive the cost of therapy further.
The flip side of research is the failure rate, also called as attrition rate.
High attrition rate of cancer research is also partly attributed to increasing
cost of cancer therapy. The average success rate of drugs for first-in-man to
registration across the most therapeutic segments is about 11 per cent, while
in cancer it is less than 5 per cent.
As the cost of therapy is a factor of cost of research, the impact is very
significant in the case of cancer. The total annualized cost per approved drug
is second highest for any cancer drug, about $1.04 billion and is just next to
respiratory drugs.
Do oncologists drive the cost of therapy?
In a disease area like cancer, where multimodality option (surgery, radiation,
chemo, hormones and biologics) is available, oncologists play a critical role
in treatment decisions. Yet, it is unclear whether they prescribe high-cost new
treatments to offer good value or not, apart from how therapeutic cost factors
affect their treatment recommendations.
In a survey of 139 academic medical oncologists in the US, only 30 per cent
agreed that the costs of new cancer drugs influence treatment recommendations,
while 77.5 per cent emphasised that every patient should have access to
effective cancer treatments regardless of their cost.
While we analyze the reasons for increasing cost of therapy, it is imperative
to review whether the cost is justified or not. Cost effectiveness of cancer
drugs can best be analyzed by improvement in survival rate. Let us take a look
at a few examples of cost of new drugs vis--vis the survival rate in comparison
to existing drugs, which are considered as reference drugs.
In the case of advanced metastatic breast cancer, the increase in survival rate
is just 3 months with the new drug (Trastuzumab) over the reference drug
(Paclitaxel). However, the cost is increased by 6 times per cycle. In the case
of follicular lymphomas, though the response is nil and the cost is increased
by 7 times over reference drug (Fludarabine), the new drug (Rituximab) is
preferred because it offers targeted therapy.
Increase in cost of modern cancer drugs is not justified with the improvement
in survival rate. Hence, the cost effectiveness of the drugs could not be
established. However, they reduce side effects and improve the quality of life.
Research by Indian companies can offer respite from these expensive cancer
drugs. Dabur Pharma launched a novel drug delivery system (NDDS) for the widely
used breast cancer drug Paclitaxel, which is priced much lesser than a similar
product called Abraxane that is available in the US. Dr. Reddy's Laboratories
developed Rituximab and priced it at half the price of Roche's Mabthera for the
treatment of non-Hodgkin's lymphoma.
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