In the last two decades, numerous new drugs have come to market and turned some cancers that used to be death sentences into manageable or even curable diseases. But one significant hurdle remains: They’re often incredibly expensive. So the question that faces payers, physicians and ultimately patients is how to balance the high cost of new cancer therapies – particularly cutting-edge ones like cell therapies – with the value they add to the healthcare system.
That will be the topic of a panel discussion at the upcoming MedCity CONVERGE conference, “Value and Cost of Novel Cancer Treatments,” taking place June 19 in Philadelphia. The panel discussion will bring together Jim Caggiano, CEO of Dendreon Pharmaceuticals; Julie Kennerly-Shah, assistant director of pharmacy at the Ohio State University Comprehensive Cancer Center; and Hiroomi Tada, chief medical officer of Notable Labs.
“It’s something that we’ve always struggled with,” Tada said in a phone interview, referring to the question of value versus cost.
For example, compared with the US, drugmakers can charge whatever they want to, which works well for their bottom lines and may also help spur innovation, but also contributes to the high cost of healthcare here. On the other extreme is the UK, where the National Health System’s drug-pricing watchdog, the National Institute for Health and Care Excellence (NICE), limits new treatments to a cost of 30,000 pounds ($38,892) per quality-adjusted life year. Cost per QALY, also known as an incremental cost-effectiveness ratio, or ICER, means the cost of one year of perfect health.
“I think that’s in many ways restrictive because it doesn’t allow novel medicines to make it into the UK system very quickly,” Tada said.
In February, NICE recommended coverage for Novartis’ CAR-T therapy, Kymriah (tisagenlecleucel), under the Cancer Drugs Fund for diffuse large B-cell lymphoma while more data were collected to support its value to the healthcare system, in return for a confidential discount from the Swiss drugmaker. In the US, Kymriah has a list price of $373,000 for DLBCL, on top of supportive care costs that can equal or exceed that price. The list price for acute lymphoblastic leukemia in children and young adults is $475,000.
But Caggiano drew a distinction between drugs used more regularly that may be priced too high – such as oral anti-androgens used in prostate cancer – and immunotherapy drugs or patient-specific therapies like CAR-T cells.
“When you think about drugs like the CAR-Ts, that’s not pills in a bottle – it’s not scalable,” Caggiano said in a phone interview. Every dose that Dendreon makes of Provenge (sipuleucel-T), he said, involves live cells harvested from the patient that are then shipped to the plant, turned into Provenge and then shipped back for infusion, without any cryopreservation.
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When Provenge was launched in 2010 with a $93,000 list price, the 4.1-month improvement in survival that it produced raised questions about its value. But today, even with a $120,000 list price, it now extends survival by a median of one year thanks to improvements in diagnostics. “The reality is that our drug makes men with prostate cancer live for a year longer than they would have,” Caggiano said, and without the co-treatment costs that come with CAR-T therapies. “Certainly, if [Provenge] was approved today with a year-plus improvement, it would probably be a heck of a lot more than $120,000.”
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