Are cancer meds worth the cost?

Are expensive cancer drugs a contemporary version of the emperor's new clothes? The Journal of the National Cancer Institute says they just might be. After analyzing data from existing studies, researchers found that some of the costliest drugs in medicine only prolong patient's lives by months, or even weeks. Eli Lilly and Bristol-Myers Squibb's Erbitux, for instance, prolongs survival in lung cancer patients by 1.2 months, they found, at a cost of $80,000 for an 18-week course of treatment. 

The authors also raised questions about the cost-effectiveness of Avastin, Roche's big-time drug, and Nexavar, which is co-marketed by Bayer and Onyx Pharmaceuticals. And as the Wall Street Journal reports, they contended that drugs shouldn't be tested unless they can be sold for $20,000 or under per treatment course. More than 90 percent of the new cancer drugs approved in the U.S. over the past four years cost more than that, they said.

There are some obvious flaws in this analysis, however; as a Bristol-Myers spokesman told the WSJ, $80,000 is like a "sticker price" for Erbitux, but the street price is closer to $10,000 a month (by our calculations, that's $45,000 for 18 weeks). Besides, Erbitux isn't approved as a lung cancer treatment, so focusing on cost-effectiveness for that indication is a bit disingenuous.

Plus, the 1.2 month survival advantage is an average. And for some patients, Erbitux works incredibly well, while for others it doesn't work well at all. Should the drug be disregarded completely because the non-responders bring the average way, way down? In fact, there's been lots of discussion among oncology researchers, doctors, and drugmakers about targeting treatment with drugs like Erbitux to patients with a particular genetic makeup. Amgen even asked the FDA to restrict Vectibix's label to patients without the mutated form of the KRAS gene. 

The debate over costly drugs has only just begun. With healthcare reform in the works as we speak, the super-expensive meds are sure to attract plenty of attention from cost-cutters in Congress. But the issue is lots more complicated than the executive-summary numbers show. Knee-jerk policy changes would have plenty of unintended consequences, so we hope our lawmakers read the fine print before acting.

- read the Bloomberg story
- check out the WSJ coverage