• 3/27/2006
  • Chicago, IL
  • Jim Ritter
  • Chicago Sun-Times (www.suntimes.com)

A new generation of high-tech cancer drugs is extending patients’ lives, but the costs are stunning.

Take Erbitux, approved for advanced colorectal and head-and-neck cancers. It costs $327 a day, $9,800 a month, $118,000 a year. And that doesn’t count the cost of administering the intravenous drug

New drugs for non-Hodgkin’s lymphoma and for lung, breast, pancreatic, kidney and stomach cancers also cost thousands of dollars a month. Drug companies are seeking to expand the lucrative market by testing the drugs on other cancers. They also are developing new drugs.

“Some of these agents are outrageously expensive,” said Loyola University Health System oncologist Dr. Patrick Stiff.

Expensive to Make

Drug companies make no apologies. They say their new drugs are much more expensive to make than traditional chemo drugs. Companies say they need to recoup the hundreds of millions of dollars it can take to bring a new drug to market. It’s a risky business. Many drugs that work well in the lab and in animals fail in human trials.

For example, Onyx Pharmaceuticals has been in business 14 years and raised $700 million from investors. But so far, Onyx has brought only one drug, Nexavar, to market. Nexavar, for advanced kidney cancer, costs $4,333 a month.

“Given the time, the odds and the cost, there has to be a return for the capital that goes into it,” Onyx CEO Hollings Renton said.

None of the new drugs cure cancer, and for many patients, they don’t help at all. But for some patients who have advanced cancers that have not responded to other treatments, the drugs halt or shrink tumors for weeks or months. And the side effects often are less toxic than standard chemotherapy.

Patients thankful despite cost

Patients typically take the new drugs until the cancer progresses. For example, patients with advanced colorectal cancer took Avastin ($4,400 a month) an average of 10 months in a clinical trial. The median survival was 20 months, compared with 15 months for chemotherapy alone.

Cindy Welker, 44, of Downers Grove, is among the patients who are thankful for Avastin. Although Welker’s colon cancer has spread to her ovaries and abdominal wall, the combination of Avastin and other drugs has held the tumors in check, and Welker feels fine. Her church raised $17,000 to help pay for drug costs not covered by insurance.

Traditional chemotherapy drugs work by killing healthy cells as well as cancer cells. The new drugs, called “biologics,” specifically target cancer cells by, for example, cutting off the tumor’s blood supply. Consequently, patients typically experience fewer side effects.

Industry critics concede that cancer drugs are expensive to develop. But they also give another reason for the astronomical prices: the industry-friendly health care system in the United States.

Most industrialized countries control drug prices, but not the United States. Congress has prohibited Medicare from even negotiating prices with drug companies. So with patents protecting new drugs from generic competition, drug companies “can charge whatever they want,” said University of Chicago oncologist Dr. Mark Ratain.

Conflict of interest for docs?

Many of the new drugs are given intravenously. Unlike pills purchased at a pharmacy, intravenous drugs are sold by doctors, often at a big markup. Critics say it’s a conflict of interest for doctors to profit from the drugs they prescribe.

“The incentives are a little perverse,” said Dr. Deborah Schrag of Memorial Sloan-Kettering Cancer Center.

A recent study published in the journal Health Affairs found that doctors who were more generously reimbursed prescribed more-expensive drugs to patients with advanced breast, lung and colorectal cancers.

When deciding whether to approve a new drug, the Food and Drug Administration considers only whether the drug is safe and effective. The FDA does not consider cost.

“A lot of these drugs are not cost-effective,” Ratain said.

One traditional measure of cost-effectiveness in medicine is to set a maximum cost of $50,000 per “quality-adjusted life year.” A treatment is considered cost-effective if, on average, it costs less than $50,000 to provide a patient with one year of good health.

By that standard, new cancer drugs often aren’t cost-effective. Suzanne Lindley of Canton, Texas, estimates her insurance has paid more than $2 million on the 15 drugs she has taken since she was diagnosed with colon cancer six years ago.

Even though the cancer has spread to her liver, lungs and spine, Lindley remains healthy enough to raise two teenage daughters and coordinate the Colon Cancer Alliance’s buddy program.

Lindley doesn’t believe drugs should be subjected to cost-benefit formulas. “Would you want a price put on your life?” she said.

Even with insurance coverage, patients face high co-pays

Despite the high cost of new cancer drugs, most patients are able to get treatment.

Medicare, Medicaid and private insurers generally cover cancer drugs once the drugs are approved by the Food and Drug Administration. And drug companies say they provide the drugs free of charge to many patients who lack insurance.

But there are gaps. Some insurance plans require patients to pay 10 percent or 20 percent of drug costs, and many patients can’t afford these co-pays. “There still are patients who wind up strapped,” said Suzanne Lindley, coordinator of the Colon Cancer Alliance’s buddy program. “Sometimes they don’t get treatment.”

Several patient-advocate foundations give money to patients to help fund insurance co-pays and Medicare coverage gaps.

Drug companies have donated millions of dollars to the foundations. The money cycles from the foundations to the patients and then back to the companies. In effect, the drug companies are donating money to themselves.