With all the talk of rising prices for cancer medications, the cost of healthcare and comparing the value and benefit of competing drugs, Memorial Sloan-Kettering Cancer Center has decided not to use a newly approved treatment for metastatic colorectal cancer. The leading hospital says it will exclude the new colorectal cancer drug Zaltrap which is marketed by Sanofi and Regeneron, from its treatment protocol.
Why? The price - which is twice as high as competing drugs,such as Roche’s Avastin, but has proven no more effective. Writing in the Opinion Pages of the New York Times, three doctors from the cancer center explaining their case. They note that FDA, Medicare and organizations that set physician guidelines pay attention to effectiveness; private insurers then follow suit, since they are expected to be held to the same standard. “Ignoring the cost of care, though, is no longer tenable,” they write, adding they feel obligated to consider financial strains that result.
“This is particularly the case with cancer, where the cost of drugs, and of care over all, has risen precipitously,” they continue. “The typical new cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000. Two of the new cancer drugs cost more than $35,000 each per month of treatment.”
In explaining the rationale, they point out that the drug offers the same survival benefit as Roche’s Avastin, which has a similar mechanism of action. Writing, they state, “When compared with the standard chemotherapy regimen alone, adding either medicine has shown to prolong patient lives by a median of 1.4 months. Major clinical practice guidelines, like those from the National Comprehensive Cancer Network, agree that Zaltrap is no better than Avastin in this setting,”.
They note that Avastin offers some advantages – a monthly cost of $5,000, which is less than of the cost for Zaltrop, and it is takes less time to administer, while side effects are roughly equal. They then note that “an older colorectal cancer patient without extra insurance would have to pay more than $2,200 out of pocket for a month’s treatment with Zaltrap.”
The problem, they say, is that because our medical culture equates “new” with “better” so unequivocally, a decision like this one can seem out of place at a leading cancer hospital.” And they then point out that “political rhetoric today is similarly slanted. Our refusal to adopt his remarkably expensive therapy risks being labeled rationing, not rational.”
The cancer center’s decision, they note, will most likely not have any meaningful effect, given that health care spending is so high and Zaltrap sales in the US are expected to amount to 0.005% of all dollars spent on health care next year. However, they conclude “But it is a step in the right direction — one of many we need to take,”.
Such sentiments are hardly uncommon these days, but they note that the rhetoric over health care explains why the Affordable Care Act precludes Medicare from changing its coverage or payment amounts based on cost comparisons. And while Americans do tend to trust their doctors, Medical practitioners just might get away with the kind of action that government programs can't. "If no one else will act, leading cancer centers and other research hospitals should," the Sloan-Kettering authors wrote. With so many drug makers pinning their hopes on targeted cancer drugs, that could be a chilling prospect. You decide - rationing or rationale.