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Lowering the High Cost of Cancer Drugs—I

      To the Editor:
      In the August 2015 issue of Mayo Clinic Proceedings, the article by Tefferi et al
      • Tefferi A.
      • Kantarjian H.
      • Rajkumar S.V.
      • et al.
      In support of a patient-driven initiative and petition to lower the high price of cancer drugs.
      on the high cost of cancer drugs left many issues unaddressed or underaddressed.
      First, the article could have questioned how the big pharmaceutical companies have always obtained drug prices that are not related to the true research and development costs, these costs being inferior to the marketing one.
      • Gagnon M.A.
      New drug pricing: does it make any sense?.
      Second, the claim that “The good news is that effective new cancer therapies are being developed by pharmaceutical and biotechnology companies at a faster rate than ever before”
      • Tefferi A.
      • Kantarjian H.
      • Rajkumar S.V.
      • et al.
      In support of a patient-driven initiative and petition to lower the high price of cancer drugs.
      is far from evidence based. Easy-ride regulators are failing to compare new with current effective therapy using designs that are methodologically rigorous, and the use of surrogate end points replaces evidence with hope.
      • Light D.W.
      • Lexchin J.
      Why do cancer drugs get such an easy ride?.
      • Braillon A.
      Surrogate end points for overall survival: festina lente (more haste, less speed).
      Drug prices are not related to their therapeutic value. This is a general issue, not specific to cancer drugs. Under current pricing, noninnovative “me-too” drugs are priced as high or higher than older drugs, without being more effective. The system has artificially increased the incentives for developing noninnovative me-too drugs rather than innovative medicines for unmet needs.
      • Fojo T.
      • Mailankody S.
      • Lo A.
      Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture.
      As a result, in 2013, spending on specialty drugs, a category dominated by cancer drugs, totaled $73 billion. That year, 8 new cancer drugs were approved by the US Food and Drug Administration. The Medicare price, which includes patient coinsurance, for these 8 drugs ranged from $7000 to $12,000 per month, with some agents producing overall survival improvement of nearly 6 months and others producing no improvement in overall survival.
      • Bach P.B.
      Indication-specific pricing for cancer drugs.
      Last, the 30th World Oncology Forum convened by the European School of Oncology in 2012 with the task of evaluating progress to date in the war against cancer concluded that current strategies for controlling cancer are clearly not working. It issued a remarkable action plan that was concise: there were only 10 actions, with the war on tobacco being first.
      Stop cancer now!.
      As Albert Einstein said, “Problems cannot be solved with the same mind set that created them.” We need innovative solutions if drug pricing is to become more appropriate and affordable.

      References

        • Tefferi A.
        • Kantarjian H.
        • Rajkumar S.V.
        • et al.
        In support of a patient-driven initiative and petition to lower the high price of cancer drugs.
        Mayo Clin Proc. 2015; 90: 996-1000
        • Gagnon M.A.
        New drug pricing: does it make any sense?.
        Prescrire Int. 2015; 24: 192-195
        • Light D.W.
        • Lexchin J.
        Why do cancer drugs get such an easy ride?.
        BMJ. 2015; 350 ([editorial]): h2068
        • Braillon A.
        Surrogate end points for overall survival: festina lente (more haste, less speed).
        Ann Oncol. 2015; 26 ([letter]): 818
        • Fojo T.
        • Mailankody S.
        • Lo A.
        Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture.
        JAMA Otolaryngol Head Neck Surg. 2014; 140: 1225-1236
        • Bach P.B.
        Indication-specific pricing for cancer drugs.
        JAMA. 2014; 312: 1629-1630
      1. Stop cancer now!.
        Lancet. 2013; 381: 426-427

      Linked Article

      • In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs
        Mayo Clinic ProceedingsVol. 90Issue 8
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          The high prices of cancer drugs are affecting the care of patients with cancer and our health care system.1 In the United States, the average price of new cancer drugs increased 5- to 10-fold over 15 years, to more than $100,000 per year in 2012. A study by Howard et al2 documented the escalation in cancer drug prices by an average of $8500 a year over the past 15 years. The cost of drugs for each additional year lived (after adjusting for inflation) has increased from $54,000 in 1995 to $207,000 in 2013.
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      • In Reply—Lowering the High Cost of Cancer Drugs
        Mayo Clinic ProceedingsVol. 91Issue 3
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          We thank our colleagues for their perspectives on our commentary.1 We agree with the comments of Drs Braillon and Martenson, and we thank Dr Messori and coauthors for their thoughtful analysis.
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