High Price of Cancer Drugs Is Harming Patients

Zosia Chustecka

May 01, 2013

The extremely high prices of recent cancer drugs "may be causing harm to patients," a large group of international leukemia experts warns.

In a forum article published online April 25 in Blood, the group of 120 experts from around the world discuss the high cost of leukemia drugs, but emphasize that their concerns extend to many other types of cancer drugs.

The high price of drugs has resulted in nonadherence to treatment, they note. In the United States, about 10% of patients fail to take prescribed drugs, largely because of cost. "This is reducing their chances of survival," they point out.

"Advocating for lower drug prices is a necessity to save the lives of patients who cannot afford them," the group writes.

They intend to begin a dialogue by organizing regular meetings with all parties concerned "to address the reasons for high cancer drug prices and offer solutions to reduce them."

The corresponding author for the group is Hagop Kantarjian MD, from the Department of Leukemia at the University of Texas M.D. Andersen Cancer Center in Houston.

Spiraling Cost of Cancer Drugs

Cancer drug prices in particular are sky high; costs have almost doubled over the past decade, from an average of $5000 per month to $10,000 per month.

Eleven of the 12 drugs approved by the US Food and Drug Administration (FDA) last year for various cancer indications were priced above $100,000 per year, the experts note.

There were 3 news drugs approved by the FDA in 2012 for chronic myeloid leukemia (CML) — all BCr-Abl tyrosine kinase inhibitors (TKIs). All were "priced at astronomical levels," they write. Ponatinib (Iclusig, Ariad) costs $138,000 annually, omacetaxine (Synribo, Teva) costs $28,000 for induction and $14,000 for a maintenance course, and bosutinib (Bosulif, Pfizer) costs around $118,000 per year.

Even the original drug in this class, imatinib (Gleevec, Novartis), which was launched in 2001 at a price of $30,000 per year, has had a huge price hike; in 2012, it cost $92,000 per year.

This is despite the fact that all the research costs for imatinib were accounted for in the original price, the experts points out, and that since its launch, the drug has been approved for other indications, so the number of patients taking the drug has increased dramatically. There have been numerous appeals by patients and advocates to lower the price of imatinib, but to no avail, the group reports.

In a letter published in response to the forum article, Hervé Hoppenot, president of Novartis Oncology, emphasized its patient access programs, in which the company provides drugs for free. In the past 5 years, those programs have provided imatinib or its follow-up drug nilotinib (Tasigna) to an average of 5000 uninsured or underinsured American patients annually, he reports. Globally, nearly one third of the imatinib manufactured annually is provided at no cost, which amounts to more than 50,000 patients in more than 80 low-income countries to date, he adds. However, he does not comment on the price of imatinib or explain why it has risen since its launch.

Most Successful Targeted Therapies

These TKIs have become the most successful class of targeted therapies ever developed in cancer, exceeding all projected survival expectations, the experts note.

"Patients with CML now live close to normal life spans, as long as they receive the appropriate TKIs and adhere to treatment," they explain.

But therein lies the rub: "Daily therapy is required indefinitely to produce the anticipated benefit of long-term survival."

"Grateful patients may have become the 'financial victims' of the treatment success, having to pay the high price annually to stay alive," they write.

In the United States, patients have to pay out of their own pocket a portion of the cost of the drugs they take — on average 20%.

For a CML patient taking a TKI, the 20% copay amounts to around $20,000 to 30,000 per year (about a quarter to a third of an average household budget).

This is resulting in financial ruin for some patients; medical illness and drug prices are the single-most frequent cause of personal bankruptcy, the group notes.

The high cost is also stopping some patients from taking the drug. The group notes that survival rates are lower in the general population of CML patients in the United States than those reported in clinical trials and from countries such as Sweden, where there is no copayment for medicine, and they suspect that lower treatment penetration rates are to blame.

"Unaffordable drug prices in CML may be preventing many patients from accessing these life-saving drugs," the group notes.

"Lowering the prices of TKIs will improve treatment penetration, increase compliance and adherence to treatment, and expand the population of patients with CML who live longer and continue on tyrosine kinase therapy," the experts note. Paradoxically, as a result of all this, lowering the price would ultimately increase revenues to pharmaceutical companies selling these drugs.

Dr. Kantarjian reports receiving research grants from MBS, Novartis, Ariad, and Pfizer, and acting as a (nonpaid) consultant to Novartis.

Blood. Published online April 25, 2013. Abstract, Letter

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