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The High Cost of Cancer Drugs and What We Can Do About It

      Last year, ipilimumab (Yervoy; Bristol-Myers Squibb, New York, NY) was approved by the Food and Drug Administration (FDA) for the treatment of metastatic melanoma. The benefit in survival over and above standard treatment arms was 3.7 months in previously treated patients and 2.1 months in previously untreated patients.
      • Hodi F.S.
      • O'Day S.J.
      • McDermott D.F.
      • et al.
      Improved survival with ipilimumab in patients with metastatic melanoma.
      • Robert C.
      • Thomas L.
      • Bondarenko I.
      • et al.
      Ipilimumab plus dacarbazine for previously untreated metastatic melanoma.
      The cost: $120,000 for 4 doses. As staggering a figure as that is, the drug is hardly alone in its lofty price. We believe that the immense cost of contemporary cancer drugs signals even greater costs for future drugs ( Table) .
      TABLE Cost of Selected Drugs Used in Cancer Therapy
      a The costs listed are approximate estimates based on average wholesale prices and typical schedules used in practice. Costs are higher when the cost of administration is factored in and when 2 or more drugs are used in combination.
      Generic drug name (trade name; manufacturer, location) Cancer Typical treatment schedule Cumulative drug cost for 1 y ($) Comments
      Ipilimumab (Yervoy; Bristol-Myers Squibb, New York, NY) Melanoma Once every 3 wk for 4 doses 120,000 Duration not well defined; currently, physicians have been going past the 4 doses if patients have achieved a good response
      Sipuleucel-T (Provenge; Dendreon Corp, Seattle, WA) Prostate cancer Three doses over 1 mo 90,000 for 3 doses
      Bevacizumab (Avastin; Genentech Inc, South San Francisco, CA) Various cancers, including lung and colon cancer Once every 3-4 wk 90,000 Can be continued >1 y until disease progression
      Paclitaxel, protein-bound (Abraxane; Celgene Corp, Summit, NJ) Breast cancer Three times a month 80,000 Continued until disease progression
      Lenalidomide (Revlimid; Celgene Corp) Multiple myeloma Daily for 3 wk of each month 90,000 In frontline and maintenance, duration of therapy can exceed 3 y; in relapsed disease, duration is approximately 1 y
      Bortezomib (Velcade; Millennium Pharmaceuticals, Cambridge, MA) Multiple myeloma Once weekly 60,000 Can be continued >1 y until disease progression
      Imatinib mesylate (Gleevec; Novartis Pharmaceuticals Corp, East Hanover, NJ) Chronic myeloid leukemia Once daily 70,000 Lifelong until progression
      Alemtuzumab (Campath; Genzyme Corp, Cambridge, MA) Chronic leukemias Three times a week for 3 mo 70,000 Could be used for >1 y
      Ofatumumab (Arzerra; GlaxoSmithKline, Philadelphia, PA) Lymphomas and chronic lymphoid leukemias Twelve doses over 3-4 mo 120,000 Could be used for >1 y
      Brentuximab vedotin (Adcetris; Seattle Genetics Inc, Bothell, WA) Hodgkin lymphoma Once every 21 d for 8 cycles 100,000 Approximately 6-8 cycles in a year
      Dasatinib (Sprycel; Bristol-Myers Squibb) Chronic myeloid leukemia Once daily 110,000 Lifelong until progression
      a The costs listed are approximate estimates based on average wholesale prices and typical schedules used in practice. Costs are higher when the cost of administration is factored in and when 2 or more drugs are used in combination.

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      Linked Article

      • The High Cost of Cancer Drugs and What We Can Do About It
        Mayo Clinic ProceedingsVol. 88Issue 3
        • In Brief
          Having rejected willingness to pay and the free marketplace as valid instruments to value health care interventions or to price pharmaceuticals, many health economists have turned to quality-adjusted life years (QALYs) as a valuation measurement tool of health status utility. This same approach was used by Siddiqui and Rajkumar1 in their article, “The High Cost of Cancer Drugs and What We Can Do About It,” which was published in the October 2012 issue of Mayo Clinic Proceedings. However, using QALYs as a technique to measure health status utility has increasingly been seen as a method that is long in the tooth, and using QALYs anyway because it is all that we have for such evaluation is wearing incredibly thin.
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