Dendreon ($DNDN) may face a lot more than cost density in persuading doctors to adopt its prostate cancer vaccine Provenge. Oncologists and urologists said reimbursement issues have contributed to their slow uptake of the treatment--but the complexity of administering the drug is also a deterrent, according to a survey by Sermo, the social network for physicians. And when asked what factors were most influential in determining whether to use Provenge, more than half cited either its $93,000 price tag or its four-months-median of extra survival.
"It is a very costly medication with logistical issues with administration," one oncologist said. "Cost is definitely a consideration," another oncologist told Sermo. "And the benefit does not seem to be enough. I have not yet used this drug."
Meanwhile, one urologist said Provenge's slow uptake was due to its being "very expensive, [with] somewhat questionable data without any benefit to [progression-free survival], difficult to administer." In clinical trials, Provenge's overall survival benefit beat a placebo by a bit more than four months, but without showing an improvement in progression-free survival.
These concerns aren't limited to Provenge, either. The physicians told Sermo they're concerned about how much life-extending drugs cost. They consider the cost in light of a drug's survival benefit in clinical trials. When asked how much of a survival benefit they'd need to see to prescribe a drug at the same price point as Provenge, almost one-third of the doctors said a year or more. Almost half said at least 10 months, and 68% said at least 7 months. About a quarter said their answer would depend upon the patient.
And, when asked what the maximum price point they'd like to see on a drug that performs about as well as Provenge, 57% said $30,000 or less. Another 29% would set the price at $31,000 to $60,000. Only 6% identified Provenge's current price point--$90,000-plus--as appropriate for that level of performance.
These doctors also worry about the ability of their patients to foot their share of the bills. Co-pays for expensive meds dissuade 68% of the surveyed doctors from prescribing the drugs. Just 29% said co-pays weren't a factor in their prescribing choices. Three percent said their copay worries were restricted to potential Provenge patients.
Only 34% said cost wasn't much of an issue overall, while 38% said high drug costs would be a major deterrent, with some saying the cost would stop them from using such drugs completely. "These drugs are complex to administer, expensive, require extensive preauthorization and benefit patients fairly minimally," one oncologist said. "[The] healthcare system cannot continue to absorb these costs."
- see the survey from Sermo
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