Source: Indystar.com
Author: John Russell

Cancer doctors say thousands of dollars may buy little time

When a cancer patient is facing a steep, painful decline, the high cost of drugs may seem worth every penny.

But some cancer specialists are starting to wonder about the cost-effectiveness of some treatments and are raising pointed questions about Eli Lilly and Co.’s newest cancer drug, Erbitux.

Treating a lung-cancer patient with Erbitux costs $80,000 for an 11-week regimen, according to a study published in the June issue of the Journal of the National Cancer Institute. Yet such treatment prolongs survival by 1.2 months, the study found.

“Many Americans would not regard a 1.2-month survival advantage as significant progress,” wrote the authors, Tito Fojo, an oncologist with the National Cancer Institute, and Christine Grady, a bioethicist at theNational Institutes of Health.

The study’s findings raise the question: How can the U.S. control ever-growing health costs, particularly at the end of life?

When Lilly announced its acquisition of Erbitux last year, the drug maker said it planned to become “an oncology powerhouse.” The Indianapolis-based company has two other cancer drugs, Gemzar and Alimta, each with sales of more than $1 billion last year.

Some cancer specialists say the widespread use of expensive treatments is questionable.

“Erbitux, which costs $10,000 a month for treatment, can lead to what might be described as a marginal benefit,” said Dr. Paul Helft, an oncologist at theIndiana University Simon Cancer Center.

Some oncologists use various lengths of treatment depending on the patient and the nature of the disease.

The issue becomes complicated, Helft said, because some patients respond well with high-priced treatments, while others do not. The study looked at median outcomes.

“Some people will get absolutely no benefits, and some people will buy substantially more time from them,” he said. “It can be a very tough call.”

Some cancer survivors say the decision on which treatment to take is a wrenching process.

“This situation is most intense when people with cancer who are nearing the end of their lives must decide, in the most personal way, how to calculate the cost-benefit of continuing with treatment and what they value most in the time that remains,” said Ellen Stovall, a 37-year cancer survivor and acting president and chief executive of the National Coalition for Cancer Survivorship.

Lilly defended the drug and questioned some of the study’s findings. The company pointed out that Erbitux is not approved to treat lung cancer, the area the study looked at, only colorectal cancer and head and neck cancer.

Yet doctors are permitted to prescribe drugs for any condition, and the restrictions apply only to the drug maker’s ability to market the drugs for unapproved uses. And treating lung cancer is one goal that Lilly has for Erbitux.

Lilly also questioned the high costs and low survival rates mentioned in the study. According to Lilly, patients with head or neck cancer receiving Erbitux, along with radiation, would prolong survival by 19 months, at a cost of $19,000. For those taking Erbitux alone, the cost would be $27,000 and 5.9 additional months.

For colorectal cancer, a course of treatment in advanced stages would cost $18,000 and prolong survival 1.5 months. For those taking Erbitux and chemotherapy, it would be $38,000 and 4.1 months.

“Lilly works to improve the survival and health of cancer patients,” Lilly spokeswoman Lee Lange said. “Whether all patients should take this drug is a question for them and their doctors.”

WellPoint, the Indianapolis-based health insurer, considers Erbitux “medically necessary.” It covers the drug in its affiliated health plans, when used for colorectal, head and neck cancer and non-small-cell lung cancer.

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