NEJM: Pay attention to drugs' cost-effectiveness

The New England Journal of Medicine is amping up debate on the cost of new drugs. This week's issue includes a study that shows GlaxoSmithKline's Arixtra blood thinner helps stem problems with clotting in leg veins. But as the New York Times reports, it also includes an editorial questioning whether Arixtra's benefits are worth its price, which ranges up to $7,380 per person for 45 days of shots.

"The paradox is, it's effective, but for a condition that's usually not considered an overwhelmingly serious medical problem," Dr. Lee Goldman, who wrote that editorial, told the NYT. "The fact that it's a medicine that's expensive really raises an issue, not just for this trial, but we tried to make the point more broadly."

Indeed, as drugs with high price tags multiply--and governments and insurers worry about out-of-control healthcare costs--the cost-benefit calculus has come to the fore. The U.K.'s high-profile cost-effectiveness watchdog has been vilified for rejecting some pricey cancer treatments, but its hard-nosed approach has also prompted drugmakers to offer discounts and risk-sharing payment plans. And in the U.S., Congress has allocated new funding for comparative-effectiveness studies, but lawmakers have been careful to stipulate that the comparisons can't focus on cost.

Meanwhile, FDA is weighing whether to yank the breast cancer indication on Roche's Avastin; after-market studies showed that the drug, approved for breast-cancer use on the fast-track system, wasn't quite as effective as earlier trials suggested. Because Avastin is expensive, the agency has been accused of including cost in its decision-making, which FDA isn't allowed to do. No end to this debate anytime soon, not with healthcare costs in the daily headlines.

- see the NYT piece

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