Op-Ed of the Day: The cost of cancer

Why does health care cost so much?

This opinion piece from the New York Times explains one way. Cancer drugs cost a lot.

Doctors at Memorial Sloan-Kettering Cancer Center recently decided not to use a particular cancer drug, Zaltrap, because it was more expensive – but not any more effective – than a similar drug. Three doctors from the hospital wrote the op-ed:

The typical new cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010 the median price has been around $10,000. Two of the new cancer drugs cost more than $35,000 each per month of treatment.

The burden of this cost is borne, increasingly, by patients themselves — and the effects can be devastating. In 2006, one-quarter of cancer patients reported that they had used up all or most of their savings paying for care; a study last year reported that 2 percent of cancer patients were driven into bankruptcy by their illness and its treatment. One in 10 cancer patients now reports spending more than $18,000 out of pocket on care.

So if a doctor and patient could choose to use an effective and less expensive drug, they would. Right? Yet Zaltrap is expected to make $150 million dollars in sales next year.

In most industries something that offers no advantage over its competitors and yet sells for twice the price would never even get on the market.

Unless more hospitals and heath care systems start doing better comparison shopping, this is one part of health care costs that will remain higher than necessary.

–Stephanie Curtis, social media host

  • JBL

    All the fundraisers and benefits for those with cancer are evidence these costs are out of control. Or maybe they are part of the reason. Some people, ironically those with the greatest means to start, can raise tens of thousands off of a couple of events to subsidize over priced treatments.

    I’ve been asked to donate to an acquaintance that makes over twice what I do for a treatment for which he is a bad candidate given his advanced disease, that is ridiculously expensive and, from the research I’ve seen, doesn’t even work. But, everyone gets out their cash because we can’t say no to someone facing the thing we fear most.

    I’m not unsympathetic, but after dealing with the full course of this terrible disease up close and personal with four relatives and close friends, I have a better sense of the limits of medicine’s ability to cheat death. But it took a few dances with the whole “but you can’t give up hope” garbage before I could make rational decisions about terminal illnesses.

    As long as we are too scared to discuss the end of life honestly and face our fears of death, they’ll be steady stream of customers for over priced, under effective cancer treatments.

  • Kathryn Blume

    I am a stage IV colon cancer patient, diagnosed over 3 years ago. I have been on a few different chemo combinations through this time. I was on Irinotecan and Avastin (second-line treatment for me) for over one year. It kept me mostly stable, until the side effects of chemo became too much for me to handle. I had radiation on my remaining tumors, and had a good response, so I took a treatment break. Just recently I had progression of my disease again, and now have tumors in several distant lymph nodes and in several bones, including my spine. I had radiation to help control the bone tumors, and then started chemotherapy again. I am on Irinotecan and Zaltrap this time. I have had a much faster response to this combination than with the Avastin. My cancer marker dropped in half in just one treatment, and took another big drop after the second treatment. We won’t have complete answers to how well the Zaltrap is working until I have my next PET/CT scan. But in the past my cancer markers have been very indicative of what we will see on scans.

    What is not mentioned in comparing these two drugs is that different drugs work differently on different people. They don’t mention that while Avastin targets just one growth receptor, Zaltrap targets three. This is NOT an example of two identical drugs, where it makes no sense to pay more for an alternate. yes, the stats for median survival time are the same for the two drugs, but that means nothing. They work in similar ways, but are not the same. Can you imagine if your bacterial disease needed one type of very expensive antibiotic, like IV Vancomycin, but due to cost, you were only allowed penicillin? Sure, you have an infection and need an antibiotic, but it goes beyond that. You need the right antibiotic for your individual situation.

    What needs to be addressed are the real issues. Costs are out of control with our current drug systems. Study the systems and regulations of other countries with lower costs and see where we can make changes. More research is needed so we can establish who will benefit from which treatments. This is the real challenge – the one that is most important. We can save a lot of money and a lot of misery (treatment side effects) by knowing if a particular treatment will be of benefit to a patient in advance. Instead right now it is a crap shoot. All we can do is try what is available and see if it works.

    While I have always held the highest respect for MSKCC and Dr Salz in particular, right now I am very glad they are not my providers. In my case we are seeing Zaltrap make a difference over Avastin.

    I understand the need to get costs under control. I understand that one day, colon cancer is most likely what will kill me. But what is more important, money or life? Are we so hung up on money in our society that it is the most important thing above all else? As the cost of my medical care has ruined us financially I have felt a lot of guilt. I have wondered if it is fair to my family, or even society in general, to have so much money used to keep me alive. But then I stop and think, what exactly is money, and what is its real worth? It is a very sad day if we come to the point that the decision money is more important than human life becomes standard. Remember Hitler’s way of dealing with the sick? We could just march all cancer patients into death camps and then we won’t be a financial burden anymore.