In the New York Times, A
Cancer Drug's Big Price Rise Disturbs Doctors and Patients, is an article about Joyce Elkins personal experience
with price gouging by a pharmaceutical company. According to the article, on February 3rd, she filled a prescription
for a two-week supply of nitrogen mustard, Mustargen, a decades-old cancer drug used to treat a rare form of lymphoma,
at a cost of $77.50. Two weeks later, on February 17th, Elkins, a 64-year-old retiree, had the same prescription filled
again, only this time is cost $548.01. This is not a typo. The cost for the very same medicine went from $77.50 to
$548.01, in two weeks. Her insurance does not cover nitrogen mustard, which she must take for at least the next six
months. Mustargen, developed over 60 years ago, has been blended into an ointment by pharmacists and used as a topical treatment for cutaneous T-cell lymphoma, a cancer that primarily affects the skin. Here's what happened, and why the sharp rise in the price of Mustargen. Last August, Merck, which makes Mustargen, sold the rights to manufacture and market Mustargen to Ovation Pharmaceuticals, whose business is buying slow-selling medicines from big pharmaceutical companies. Ovation turned around and raised the wholesale price of Mustargen. This is how a medicine that has been around for over 60 years goes from $77.50 to $548.01 in two weeks. Sean Nolan, vice president of commercial development for Ovation, said that the price increases were needed to invest in manufacturing facilities for the drugs. Yeah, right. Whatever. How and where has Mustargen been manufactured for the last sixty years? Ovation isn't the only pharmaceutical company making this kind of market decision.
Genentech is planning to double the price of its colon cancer drug Avastin, to about $100,000, when Avastin's use is expanded to breast and lung cancer patients. Nothing about Avastin or Mustargen is changing but the price. I hold nothing against a business making a healthy profit, but not at the expense of a cancer patient's health. The New York Times, A Cancer Drug's Big Price Rise Disturbs Doctors and Patients, is published online. Come back, and tell me what you think.
1. The price of greed goes part and parcel with the joint Michigan/Harvard study that confirms medical oncologists choose cancer chemotherapy based on how much money the chemotherapy earns the medical oncologist.
Just published in the journal Health Affairs is a joint Harvard/Michigan study entitled "Does reimbursement influence chemotherapy treatment for cancer patients?" In a study of 9,357 patients, the authors documented a clear association between reimbursement to the oncologists for the chemotherapy of breast, lung, and colorectal cancer and the regimens which the oncologists selected for the patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist (Jacobson, M.,O'Malley, A.J., Earle, C.C., et al. Health Affairs 25(2):437-443, 2006).
Abstract: http://content.healthaffairs.org/cgi/content/abstract/25/2/437
The ASCO President says that we go by the literature, which has defined which are the best regimens. Well, how does he explain why the academics prescribe oral dose Xeloda to their metastatic breast cancer patients who aren't on their protocols, which keeps them from clogging up their chemo rooms and resources, which they want to use for the patients on their clinical trials, while the community oncologists almost universally prescribe infusion therapy, with the most popular drug being the still on patent Taxotere (docetaxel), which I do surmise has one of the best "spreads" between acquisition costs and average reimbursement.
This study adds to the 'smoking gun' study of Dr. Neil Love on the subject. The results of his survey show that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists prescribed an oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel.
In contrast, among the community-based oncologists, only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel. The existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology.
http://patternsofcare.com/2005/1/editor.htm
Once a decision to give chemo is taken, physicians receiving more-generous Medicare reimbursements used more-costly treatment regimens.
What was interesting about the "Patterns of Care" study was that it is contemporary, after the Medicare reform. It shows that the Medicare reforms haven't solved the problem. It's not that all oncologists are bad people. It's just an impossible conflict of interest, it's the system which is rotten. The solution is to change the system. So far, Medicare reform hasn't achieved that.
Two scientific "evidence-based" studies with a dose of reality.
Posted at 1:25PM on Mar 12th 2006 by Gregory D. Pawelski