Pertuzumab not "cost effective"?!

Debbie L. · 09-09-2015, 01:25 PM

“The addition of pertuzumab to a standard regimen of TH for treatment of metastatic HER2-overexpressing breast cancer is unlikely to provide reasonable value for money spent in the United States compared with other interventions generally deemed cost effective,” the authors wrote. “This analysis highlights the economic challenges of extending life for patients with noncurable disease.” Here's the link to the whole article.

This is sure to be provocative and controversial. Perhaps initially specifically to pertuzumab, but eventually for all the expensive new cancer drugs.

What do those of you who are savvy about reimbursement think? Could insurance and medicare/medical use this to deny coverage for an FDA-approved drug indication?

I'm about as frugal as one can get, but even I find this shocking. If we're going to develop and approve drugs, then any needed action on their cost should happen much sooner than when they're already out there, benefiting people. Am I overreacting?

Debbie Laxague

SoCalGal · 09-09-2015, 09:49 PM

Why does it cost so friggin' much?

"The total cost of cancer care in the United States is projected to be between $173 and $207 billion by 2020".
This preceding sentence triggers my fear of big pharma suppressing cures and maintaining treatments.

Now with the insurance weighing in, they don't want to pay for said treatment. It is a mess. It is horrible to be reduced to a statistic, and even so, I don't fit the mold. It's hard enough to fight a disease for which there is no cure, only treatments, and the potential of treatments denied by insurance just adds to the stress and burden. Very frustrating.

Pamelamary · 09-10-2015, 01:04 AM

Thanks Debbie - things seem to be getting a bit hairy! Pertuzumab has just been approved for funding in Australia for ABC women, but only first line. If you have had more than 12 months of herceptin alone, no go! Plenty of women like me who hope to use Pertuzumab eventually, are feeling a bit challenged!
Regards..... Pam

Mtngrl · 09-12-2015, 07:10 AM

Debbie, I share your unease about this conclusion, and you raise an important question about treatment costs.

When I broached the subject of "is it worth it?" with my oncologist a couple of years ago, she said, "The US spends $1 million per year per soldier in Afghanistan. Somebody apparently thought that money is well spent." That highlights a critical public policy issue. The NCI budget hasn't been raised in 10 years. In that time the budget for warfighting has doubled. We now spend around $1 trillion per year, all told, on "defense." How much is that costing per quality-of-life-adjusted year of additional life (and for whom?)

I'm not saying there should be no attention paid to medical costs. Quite the opposite. Let's start with our for-profit healthcare system in the US. Healthcare is a right, and it's something everyone needs. It should be publicly funded. Then there's the cost of research and development for new therapies. Is our system really the best one for doing that? Then there's "intellectual property" and how "the market" prices new drugs and creates monopolies. One economist has suggested that we, the people, could buy out drug patents and then have a competitive system for licensing their production. In the long run, that would be much less expensive.

Per capita costs for healthcare in the US are double what other OECD countries pay, and our results are worse, including the fact that millions of people still don't have any healthcare. Instead of focusing on one stunningly expensive new drug, we should be talking about the entire byzantine, awkward, irrational system.

kk1 · 09-12-2015, 11:46 AM

where's the like button for mountain girl's comment! It is spot on in my opinion.

donocco · 09-12-2015, 12:27 PM

As a pharmacist who owned his own small pharmacy I know something about drug prices. The increase in price is unbelelievable. There is no word in the english language to describe the situation. Words like "outrage", "sinful" etc do not do the situation justice. In 1987 the most expensive drug for chronic use was Mevacor (Lovostatin) and this was the first of many statin drugs. The price: about 95 dollars for 60 tablets. In those pre-insurance days this was outrageous. People payed for the drugs themselves. I dont know how many arguments I got into when people would accuse me of getting wealthy off their illness. My pharmacy was in Fontana, California, a small blue collar town and I knew the people pretty well. The relationship was very personal. Eventually I was able to convince them that the drug cost me more than I was charging them. People over 55 got a 5% discount. Not much but it helps.

How about today's costs. The drug Harvoni for Hepatitis C costs close to or more than 100,000 dollars for 84 tablets. Brand Donnatal, which was one of the cheapest drugs (costing say 20 dollars per hundred) now cost 800 dollars per hundred. You all know about the outrageous price of anti-cancer drugs.

For a long time I couldnt understand why th insurance companies put up with this. They are very powerful and they pay for the drugs. A course of Harvoni for hepatitis C is 100,000 dollars. Suppose CVS/Caremark, Blue Cross, Blue Shield, Health Net etc said to Gilead. " We know each Harvoni tablet is worth less than a penny in ingredients. Yet we are paying you close to 2000 dollars for each tablet. Tell you what. From now on well pay you 20 dollars a tablet." What would and could Gilead, the drug company do? Absolutely nothing. Its a take it or leave it situation.
So why dont the insurance companies do this to save money which is so important them and their stockholders.

I dont know but Ill offer a suggestion. The high obscene drug prices benefit the insurance companies as much as the drug companies. On the surface this statement sounds like the ranting of a schizophrenic. But think about it. The obscene drug prices make everybody absolutely dependent on having health insurance. The insurance companies make much mnore money on their premiums (which are going up and up) than they lose paying for drugs. If they wanted to, the Insurance companies could force the drug companies to drastically lower tomorrow. They could have done that yesterday. Im sorry if this sounds to simplistic.

Paul

Juls · 09-12-2015, 02:29 PM

The same goes for Health Boards here - why can't they negotiate cheaper prices?
It is a concern here as well - as UK Medicine Boards are cancelling or not approving drugs on cost basis. Just last week in England 3 cancer drugs cancelled (Eribulin,Lapatinib & Everolimus). I am in Scotland & currently in a Pertuzumab trial. Scottish Medicine Board has turned Pertuzumab down twice already. It is worrying to think that others may not get this drug purely on a cost basis!

Paul - Just wondering - Was Herceptin as expensive when first introduced? Is it still as expensive or has it reduced (in relative terms) because its the drug of choice for Her2? I don't know how drug companies work - but just wondering if Pertuzumab became standard treatment would price change?

donocco · 09-12-2015, 04:02 PM

Juls

I cant answer you about Herceptin. I closed my pharmacy in 1994 and Herceptin started being used around 2000. Besides I had a reetail pharmacy and herceptin, Perjeta etc are injectables. The Hospital pharmacists could tell you much more than I could.

As far as why doesnt the UK negotiate prices Ill give you a very inadequate answer based on info Ive skimmed over. You have to think of the political term "sphere of Influence." The United States and the United Kingdom are in each others "Sphere" so
politically there is a fear of "stepping on toes." Egypt is not in this sphere. Eighty Four tablets of Sovoldi (related to Harvoni for hepatitis C-Harvoni is Sovaldi plus another drug) costs about 900 dollars. Cost in the USA, 95,000 dollars.

From what Ive skimmed theses countries say to the Drug companies " Here is what we will pay, take it or leave it. If you wont take it well forget your patent and make it ourselves." If teens can make methamphetamine from Pseudoephedrine Im sure professional chemists in the various cointries can make Lapatanib, Xeloda whatever. What could be done to Nepal, Burma, Albania, Egypt etc. They are not in our economic sphere of influence. The UK is, Singapore might be, some countries in Europe. This is why these drugs are sold so cheaply.

I was thinking of you and the Metaclopropamide ve Prolactin.
Its something to be aware of but I wouldnt worry too much about it. They have used Metaclopropamide to stimulate milk secretion in nursing women by increasing Prolactin. The dosage of Metaclopropamide used is 30-40mg, much than you were probably taking.

They found increases of breast cancer in women working night shifts. They thin it is because these nurses dont get the melatonin surge in the blood from being in the dark at night. Melatonin has definite anti cancer action, definitely in breast cancer. Yet Melatonin stimulates prolactin secretion. Yet my guess is the beneficial action of melatonin against cancer outweighs any "it increases prolactin effect. The whole subject is very complicated and there is a lot of things not clear.

Paul

Juls · 09-12-2015, 05:37 PM

Paul
Thank you again!! I understand what you are saying!

Just read it costs about £45,000 approx. per year of treatment for Pertuzumab here. A sum I would be hard pushed to find if they don't approve it.

Regarding Metoclopramide - as you say not worth worrying about.

Once again Paul -Thank you for the info!
Take care
Juls