Cancer Treatment: Cost vs. Value

For many, a bill for more than a quarter million dollars is nothing to scoff at—but while treating those with cancer, these costs are all too common. Cancer drugs like Avastin, which is used as a second-line treatment after initial treatment has failed, can extend the median overall survival rate of a patient by 42 days at the cost of $5000 a month. If you extended that 42 days’ survival to a year, the regimen can average over $300,000.

“Now, that’s essentially the cost of the bare-bones drug,” Dr Leonard Saltz, an oncologist from Memorial Sloan-Kettering Cancer Center, said in a recent article. “It’s parts, not labor. No money for doctors; no money for nurses; no money for pharmacists; no money for real estate, heat, and lights; no money for the needles, the IV tubing, the IV fluids, the anti-nausea medicines, the other chemotherapies that are given, because Avastin doesn’t do anything by itself. It has to be given with other drugs … I want to emphasize it’s not that we can have a year of life saved for $303,000. That’s probably less than half of what the actual cost would be when you factor in everything.”

Newly FDA-approved drugs such as Zaltrap are likely to fall under even more astronomical financial constraints. Dr Saltz reported that Sanofi and Regeneron Pharmaceuticals, who manufacture the drug Zaltrap, said the new drug would cost almost $11,000 a month. The price of a 6-week life extension would be as high as $75,000. It’s obvious that practitioners like Saltz have difficulty rationalizing the costs of these new drugs when comparatively they provide the same benefits as existing treatments. However, if a doctor considers the actual value of a costly drug, they risk being accused of rationing healthcare.

“There is a number in people’s minds,” Saltz adds. “If you say to people, ‘I have a drug that extends life by one day at a billion dollars; shouldn’t we as a society pay for it?,’ I’m pretty confident most people would say no. If I say, ‘I have a drug that extends life by three years at a cost of $1.50,’ I’m pretty confident everybody would say, ‘Of course!’ Somewhere in there is a number, a tipping point, where we say, ‘No, we can’t.’ Right now, we’re unwilling as a society to explore where that point is. And I would argue that we have to. Wherever it may be, we have to find it.”

Around the Web

The Cost of Living [NY Magazine]