The costs associated with cancer drug prices have risen dramatically over the past 15 years, a trend concerning to many oncologists. In a new analysis, researchers at The University of Texas MD Anderson Cancer Center concluded the majority of existing treatments for hematologic cancers are currently priced too high to be considered cost-effective in the United States. Their findings were published by Chhatwal et al in the journal Cancer.1
A 2015 study2 by Saret et al suggesting that hematologic cancer drugs provide good value for money raised concerns for MD Anderson researchers Jagpreet Chhatwal, PhD, lead investigator and Assistant Professor in the Department of Health Services Research, and Hagop Kantarjian, MD, senior author and Professor and Chair of the Department of Leukemia.
The prior study calculated cost-effectiveness for these drugs based on 29 studies of 9 treatments for hematologic cancers, including chronic myeloid leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, and multiple myeloma. The results indicate that these drugs provided reasonable value for the money in the United States.
However, those cost-effectiveness calculations were performed using drug prices at the time of the original studies and often included prices from countries outside of the United States. Therefore, Drs. Chhatwal and Kantarjian performed a critical reanalysis of the prior study using current drug prices in U.S. dollars.
“We found that, in a majority of the studies, the incremental cost-effectiveness ratios … were substantially higher than the previously reported values,” said Dr. Chhatwal.
Cost-effectiveness is commonly interpreted in terms of the cost needed to gain an additional quality-adjusted life-year. A threshold value of $50,000 is widely accepted, below which the treatment can be considered cost-effective.
The researchers were able to reanalyze 20 of the 29 studies with updated drug prices in the current U.S. market. Upon doing this, they found that 63% of those studies had costs per additional life-year higher than the $50,000 threshold. Several studies resulted in costs of $210,000 to $426,000 per additional life-year, many times higher than conventionally accepted levels.
This indicates that, although the drugs may have been cost-effective originally, their current prices cannot be justified based upon improved quality of life.
One of the drugs evaluated, imatinib (Gleevec), was priced at $26,000 per year of therapy in 2001 and $132,000 per year in 2014. The price increase in imatinib and other drugs evaluated is not the result of new and improved versions, but instead is simply the result of rising prices, explained Dr. Chhatwal.
Perhaps more disturbing are the long-term implications of rising prices, explained Dr. Chhatwal. Many of these drugs need to be taken daily for years to manage cancer. Current drug prices could cause extremely large financial burdens, even for the well insured.
The authors concluded that regulating the cost of new treatments, as done in many European countries, will make health care more affordable and valuable for patients and providers in the United States. ■
1. Chhatwal J, Mathisen M, Kantarjian H: Are high drug prices for hematologic malignancies justified? A critical analysis. Cancer. June 23, 2015 (early release online).
2. Saret CJ, Winn AN, Shah G, et al: Value of innovation in hematologic malignancies: A systematic review of published cost-effectiveness analyses. Blood 125:1866-1869, 2015.