oncologists' practices "hurting" per Wall St. Journal

[Lani]

http://online.wsj.com/article/SB1215..._us_whats_news

[Chelee]

I could not access the entire article Lani posted because a subscription is necessary. So I did a search and found the article else where for those that would like to read this.

http://community.vietfun.com/showthread.php?p=6083180

Chelee

[donocco5w4]

I remember when I had my own pharmacy and the drug Mevacor was approved. Mevacor was the first of the anti-cholesteral statin drugs to be aproved and Lipitor is a more modern Statin drug.This was in 1987 and most prescription transactions were cash based ie there as no insurance , copays etc. The drug companies depended on people paying out of pocket so the price had to be what the market would bare. We pharmacists were paying about 89.00 dollars for 60 mevacor tablets and were outraged at the high price, knowing we would be selling this drug below cost with the 55+ senior citizen discount. Four months later Merck raised the price of Mevacor 20mg to an unheard of (at that time-1987) 94 dollars for sity tablets. Getting a new drug approved was extremely expensive and risky for the drug company then as it is today. Things have not changed that drastically as far as the expense of getting a new drug approved by the FDA in 21 years. What has changed is that now that the Insurance companies are paying for the drug, and can afford much more money, the drug companies have drastically raised their prices, sometimes by as much as 100 times as compared to the 1980s pre- insurance era.

There is an approved anti-cancer drug called Sutent which has been approved by the FDA for advanced renal cancer and a rare cancer known as GIST or gastro-intestinal stromal tumour. Sutent works by blocking VEGF and PDGF receptor Tyrosine Kinases and interferes with angiogenesis. The dosage in humans is 50mg daily for a 28 day cycle followed by a 2 week rest period, as the drug can cause severe fatigue, even in mice. The cost (if not insurance approved) for twenty eight 50mg Sutent tablets enough for one cycle) is over 7000 dollars. Sutent is a tablet and I doubt it costs the drug company a penny to make 100 tablets. Of course the research needed to get the drug approved was expensive, very expensive but probably not that much more expensive than the money needed to get Mevacor approved. Yet Mevacor only cost the pharmacist 89.00 for sixty tablets as compared to thousands of dollars as compared to the cost of twenty eight 50mg Sutent tablets. It is a scary situation.

Paul

[gdpawel]

Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. Social science research shows that people can be biased by self-interest without being aware of it. There are so many ways for humans to rationalize their behavior.

There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no Chemotherapy Concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time when people make their most important decisions in life, they are in the most idealitstic period of their lives.

The U.S. government wasn't reducing payment for cancer care under the new Medicare Modernization Act (MMA) of 2003. They were simply reducing overpayment for chemotherapy drugs, and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive.

Although the new Medicare bill tried to curtail the Chemotherapy Concession, for the most part private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and force them be doctors again.

Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003 Jul 9;290(2):252-5

[runtolive]

donocco.. u make some valid points, but take a simplistic view of drug research costs, and the costs associated with marketing and supplying this drug .. sutent . to the world.

it costs the drug companies between 50-100k per patient to run clinical trials.. about 40 patients in a phase 1 / 100 patients in a phase 2 / and 200 -500 patients typically in a phase 3 for an oncology drug.

and that is just the trial cost/ this excludes any development /productions costs of the drug.

the costs for manufacturing mevacor..pennies as you say vs sutent.. dollars are minimal.

run

[donocco5w4]

Run

I know my knowledge of pharmacoeconomics is simplistic but I "picked on" Sutent for a reason. In one experiment with a transplanted pancreatic tumour in mice combinations of Varying dosing schedules of Cytoxan (acute high dose Cytoxan followed by chronic low dose Cytoxan plus chronic SU-11248 (the experimental designation of Sutent before it was approved by the FDA) actually seemed to turn the fatal cancer into what seemed to be a chronic disease, sort of like treating diabetes with Insulin.

I realize this statement is simplistic also and Im certainly not suggesting that becase Sutent seems to act this way in a transplanted mouse cancer ( an artificial contrived situation) it would do the same in spontaneous human cancers which involve years of cumulative genetic transformations.

In the old pre Insurance days an Oncologist could prescribe a drug like Sutent for his patients based on what he or she has researched and knowledge is accumulated. Things are very different now with restrictive formularies.

Is it indeed true that marketing Oncology drugs is so many times more expensive than medications for other conditions. There is a new drug for the threatment of HIV infection called Selzentry and a month supply of this drug ( say sixty 300mg capsules) while still very expensive is a fraction of the cost of a months supply of Sutent (1000 dollars vs 7000 dollars, as a guess). I think politics is involved as well as actual cost of marketing.

Sutent is by no means an harmless drug. It can cause fatigue (very minor) severe high blood pressure, decreased left ventricular ejection fraction, severe edema, hand foot syndrome, hemmhorages in the actual tumours, anemia, thrombocytopenia etc etc. Anyone on this medication has to be closely monitored.

Paul