Current blood cancer drug prices not justified, study finds

There have been substantial improvements in survival and quality of life after treatment for hematologic cancers in recent years, but drug costs have also skyrocketed. High prices have placed a significant financial burden on patients facing these diseases, especially in light of falling household income levels. In fact, up to 20 percent of patients may forgo treatment or significantly compromise their treatment plan due to high drug costs, according to a 2014 study.

A 2015 report suggesting that hematologic cancer drugs provide good value for money raised concerns for MD Anderson researchers Jagpreet Chhatwal, Ph.D., study lead and assistant professor, Health Services Research, and Hagop Kantarjian, M.D., senior author and professor and chair, leukemia.

The prior study calculated cost-effectiveness for these drugs based on 29 studies of 9 treatments for hematologic cancers, including chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL), non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM). The results indicate that these drugs provided reasonable value for the money in the U.S.

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 U.S., the researchers explain. Therefore, Chhatwal and Kantarjian performed a critical re-analysis 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 (ICERs) were substantially higher than the previously reported values,' says Chhatwal. 'This led us to the conclusion that current prices are too high to say that the drugs provide a good value for the money.'

Cost-effectiveness is commonly interpreted in terms of the cost needed to gain an additional quality year of life. A threshold value of $50,000 is widely accepted, below which the treatment can be considered cost-effective.

The researchers were able to re-analyze 20 of the 29 studies with updated drug prices in the current U.S. market. Upon doing this, they found that 63 percent 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, 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 charged by drug companies, explains Chhatwal.

This is not the case only for hematologic cancer drugs, but is evident across the spectrum of new cancer therapies. In fact, rising drug prices were recently the target of much criticism at the 2015 American Society of Clinical Oncology Annual Meeting in Chicago.

'The trend for drug prices continues to go upward,' says Chhatwal. 'This is very concerning, particularly for new drugs coming to market soon that are almost all priced above $100,000 per year of treatment. This is becoming very unaffordable and unsustainable.'

Perhaps more disturbing are the long-term implications of rising prices, explains Chhatwal. Many of these drugs are meant 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 argue that many patients cannot afford the treatments and will be forced to decide between using financial resources to prolong their lives and saving money for their families in the future. They conclude 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 U.S.