Advances in new cancer drugs may not be enough to justify their five- to six-figure price tags
Since January 2015, Health Canada has allowed 17 cancer drugs to come on the market. While all of them come with steep costs, only three showed any real evidence of improved “overall survival” when approved by the regulator.
That was the major finding reported in a recent feature by the National Post. While follow-up trials after approval showed survival benefits for four others — extending lifespans from 1.4 to six months on average — the results for more than half left significant doubt on whether they actually bought sick patients more time than existing treatments could.
The list prices for the new cancer drugs ranged from $4,700 to $33,000 a month, leading to potential annual costs from $56,400 to $132,000. “It is becoming increasingly difficult to disregard … side-effect costs, costs to quality of life and financial costs … especially when the benefits are very, very small,” Dr. Chris Booth, oncology professor and researcher at Queen’s University in Ontario, told the Post.
This was not lost on the Pan-Canadian Oncology Drug Review, which has recommended against provincial coverage for six out of the 17 medications. Its decision is pending on four, while the other drugs got a thumbs up conditioned on their list price being lowered.
Some have called on regulators like Health Canada to require more substantial benefits before approving a cancer drug. Others warn, however, that such an approach might squeeze out medications that benefit certain subsets of patients, which may not be reflected in clinical trials.
Succumbing to the urgency felt by many patients, regulators around the world have relaxed their requirements, accepting findings that show drugs can shrink tumours or stop them progressing in lieu of proof that they actually extend patients’ lives significantly. Some have turned out to be good bets after coming out to market, but others have not — including the 17 drugs approved by Health Canada. Many have shown limited benefit, while others have been reported to cause harmful and potentially lethal side effects.
Drug companies argue that the hefty price tags reflect not just benefits to patients, but also the costs incurred in research and development. However, some of their drug pricing policies seem irrational. For example, the Novartis-made drug Afinitor costs $7,000 a month, regardless of whether the dose is 10 mg, 5 mg, or 2.5 mg. Until last year, Canadian patients had to pay double that for a 7.5-mg prescription, which entailed a combination of two different, smaller-dose pills.
Whatever the reason behind it, the high prices of cancer drugs add to the pressure applied by expensive “specialty” medications on public and private funders. While provinces can band together and try to haggle, workplace drug plans that support millions of Canadians must pay the list price. Forced to consider their sustainability, many plans have put lifetime or annual caps on drug costs they’ll reimburse, according to Deb Maskens, who founded the advocacy group Cancertainty.
Aside from the caps, the format that new drugs are coming in can lead to increased out-of-pocket costs for patients. It’s expected that by 2020, 60% of cancer drugs will be available as oral pills or injectables to be taken at home. That means in many provinces, where only treatment in hospitals is covered under Medicare, patients taking these treatments must deal with the expense themselves.
“It is an incredibly backwards system that penalizes you if you choose to take the drug in the comfort of your own home,” Maskens said.
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That was the major finding reported in a recent feature by the National Post. While follow-up trials after approval showed survival benefits for four others — extending lifespans from 1.4 to six months on average — the results for more than half left significant doubt on whether they actually bought sick patients more time than existing treatments could.
The list prices for the new cancer drugs ranged from $4,700 to $33,000 a month, leading to potential annual costs from $56,400 to $132,000. “It is becoming increasingly difficult to disregard … side-effect costs, costs to quality of life and financial costs … especially when the benefits are very, very small,” Dr. Chris Booth, oncology professor and researcher at Queen’s University in Ontario, told the Post.
This was not lost on the Pan-Canadian Oncology Drug Review, which has recommended against provincial coverage for six out of the 17 medications. Its decision is pending on four, while the other drugs got a thumbs up conditioned on their list price being lowered.
Some have called on regulators like Health Canada to require more substantial benefits before approving a cancer drug. Others warn, however, that such an approach might squeeze out medications that benefit certain subsets of patients, which may not be reflected in clinical trials.
Succumbing to the urgency felt by many patients, regulators around the world have relaxed their requirements, accepting findings that show drugs can shrink tumours or stop them progressing in lieu of proof that they actually extend patients’ lives significantly. Some have turned out to be good bets after coming out to market, but others have not — including the 17 drugs approved by Health Canada. Many have shown limited benefit, while others have been reported to cause harmful and potentially lethal side effects.
Drug companies argue that the hefty price tags reflect not just benefits to patients, but also the costs incurred in research and development. However, some of their drug pricing policies seem irrational. For example, the Novartis-made drug Afinitor costs $7,000 a month, regardless of whether the dose is 10 mg, 5 mg, or 2.5 mg. Until last year, Canadian patients had to pay double that for a 7.5-mg prescription, which entailed a combination of two different, smaller-dose pills.
Whatever the reason behind it, the high prices of cancer drugs add to the pressure applied by expensive “specialty” medications on public and private funders. While provinces can band together and try to haggle, workplace drug plans that support millions of Canadians must pay the list price. Forced to consider their sustainability, many plans have put lifetime or annual caps on drug costs they’ll reimburse, according to Deb Maskens, who founded the advocacy group Cancertainty.
Aside from the caps, the format that new drugs are coming in can lead to increased out-of-pocket costs for patients. It’s expected that by 2020, 60% of cancer drugs will be available as oral pills or injectables to be taken at home. That means in many provinces, where only treatment in hospitals is covered under Medicare, patients taking these treatments must deal with the expense themselves.
“It is an incredibly backwards system that penalizes you if you choose to take the drug in the comfort of your own home,” Maskens said.
Related stories:
Insurers need to look more at chronic conditions to limit plan costs
Increased hepatitis C coverage offers limited relief to plan sponsors
