As cancer drug prices climb, value not keeping pace

(Reuters Health) - The cost of new anti-cancer drugs increased more than five-fold from 2006 to 2015, but a new analysis suggests that cancer patients and insurers may be getting less for their money.

Anticancer medications account for the lion’s share of global drug spending, and the average price per month of these drugs is known to have more than doubled in recent years, Dr. Kelvin Chan of Sunnybrook Health Sciences Centre in Toronto and colleagues note in the Journal of Oncology Practice.

“To justify the increasing prices of novel oncology drugs, a parallel increasing trend in clinical benefit would be expected to ensure that value of these new treatments is maintained over time,” the study team writes.

They analyzed 42 clinical trials of anti-cancer drugs approved by the U.S. Food and Drug Administration in 2006-2015 to determine whether the drugs’ clinical benefits were also rising as prices climbed. All of the studies were in patients with advanced cancer. Monthly costs for the drugs ranged from $5,454 to $45,004, and the average was $13,176.

The average monthly cost of oncology drugs increased from $7,103 in 2006 to $15,535 in 2015, they found. And the incremental cost of new drugs - meaning the difference in cost between a full course of treatment with the new medication and a course of treatment with the older medication it was intended to replace - increased from $30,447 in 2006 to $161,141 in 2015.

Over the study period, monthly drug costs increased by 9 percent per year, while incremental costs rose by 21 percent per year.

Chan’s team used two scales, the American Society of Clinical Oncology (ASCO)’s Value Framework and the European Society of Medical Oncology’s (ESMO) Magnitude of Clinical Benefit Scale, to measure clinical benefits of the newly approved drugs. Neither scale showed any improvement in clinical benefit over time, nor were there any associations between the clinical value of a drug and its monthly or incremental cost.

“The cost is going up very steeply, and the improvements tend to be much more incremental, that’s really the fundamental issue,” Dr. Richard Schilsky, senior vice president and chief medical officer at ASCO, said in a telephone interview.

Cost increases are similar regardless of whether a drug is a “true game changer that revolutionizes the approach to treating a kind of cancer, or the drug just produces a small incremental improvement over an otherwise available therapy,” he added.

“Cost is not connected with benefit, and cost is going up quickly, and benefit is highly variable,” Schilsky said. “I think that as a society and as a healthcare system we need to introduce and experiment with some strategies that try to restore more normal market forces.”

ASCO and other groups are supporting efforts to make cancer drug costs relate to their effectiveness, he added. “We clearly need to do something,” he said. “We can’t just allow the continued escalation in pricing and cost without making any effort to tie it to the benefits the treatment delivers.”

Dr. Chan was not available for an interview by press time.

Pricing for new cancer drugs needs to be examined carefully, Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, said in a telephone interview. “There are going to be solutions I expect down the line that address the high cost of these drugs,” he said.

“That’s a legitimate, fair discussion that we need to have,” Lichtenfeld added. “Having said that, I also think we need to be looking more carefully at the impact of these drugs on survivorship, quality of life and side effects to get a much better handle on how these drugs impact patients’ lives.”

Pricing of new cancer drugs is “very much what we call a black box,” he said, noting that prices of older drugs also often increase, and that sometimes these increases seem to be more than can be justified by increases in marketing and production costs and inflation.

SOURCE: Journal of Oncology Practice, March 30, 2018.