The authors describe the cost of chronic myeloid leukemia drug treatments as having reached "unsustainably high levels".
Chronic myeloid leukemia is a highly curable disease, thanks to powerful, targeted therapies known as TKIs (tyrosine kinase inhibitors). TKIs allow patients to manage their disease with few symptoms by taking a pill that is well tolerated.
TKIs appeared on the market over ten years ago when between 10% to 29% of patients died prematurely. Today, thanks to these drugs, mortality is just 2%. The ten-year survival for CML patients has risen from 20% at the beginning of this century to more than 80% today.
Not that long ago, a patient diagnosed with chronic myeloid leukemia would be given a depressing prognosis. Today those who adhere to prescribed treatments can live normal life spans. Managing CML today has become similar to managing hypertension, diabetes and some other controllable diseases. The problem for CML patients is the astronomical cost.
Corresponding author Hagop Kantarjian, MD, chairman of the leukemia department at The University of Texas MD Anderson Cancer Center, said:
"Patients with CML have a much better outlook today than ever before, thanks to advances that have greatly improved survival rates.
But these patients now face dire financial struggles as they try to maintain their treatment regimen with the drastically inflating cost of care. And this issue likely extends to patients with other types of cancer who require ongoing treatment to maintain therapeutic benefit."
Dr. Kantarjian and team wrote that when new medications are approved for chronic myeloid leukemia in the USA, they are much more expensive than older options. This trend appears to be the case with other cancers too.
Examples of runaway prices for chronic myeloid leukemia medications:
- Of 12 drugs that were FDA-approved for various cancer indications last year, 11 cost more than $100,000 annually
- At $10,000 per month, cancer drug treatment today costs nearly twice as much as it did ten years ago
- A huge burden on families - most out-of-pocket cancer care-related costs comprise about 25% to 30% of an average annual household budget
- 18% of the US Gross Domestic Product is spent on health care, compared to between 6% to 8% in Europe. Cancer-related costs contribute heavily to these costs in America.
"A major question we need to answer is how to determine the 'right' price for these drugs. In many cases, it makes sense to let the market govern the price; however, when a product is directly related to a patient's survival over a period of years, it is critical to set a price that allows companies to profit and ensures that patients can afford their treatment. Since CML treatments must be taken on an ongoing basis, we are concerned that the surging prices are potentially harming patients."
According to some studies, up to 10% of patients in the US do not take their prescribed medications, mainly because they cannot afford them.
The Tragedy of Chronic Myeloid Leukemia - Treatable but Many DyingWith modern medications, CML survival rates have improved over the last ten years. However, the estimated survival rate today is 60%, suggesting that a significant percentage of patients with CML are not receiving the life-saving treatment, or are under-treated. The authors suggest that this "may be related in part to the high cost of these therapies."
In Sweden, where costs are much lower, resulting in much higher adherence rates, long-term CML survival is over 80%.
Dr. Kantarjian said "We believe that lowering the prices of CML drugs might improve accessibility to treatment and increase treatment adherence, effectively expanding the population of patients who live longer by continuing their TKI therapy."
Addressing the high costs of cancer drugs, especially CML will require the participation and collaboration of doctors, patients, advocacy groups, drug makers, governments entities, pharmacies and insurance companies, the authors wrote.
Dr. Kantarjian said "Identifying better ways to manage the cost of cancer care will require an evolution in thinking about current pricing-related policies and regulations, including those that limit price negotiation for Medicare coverage of treatments, as well as patent-related laws that limit the introduction of more affordable generic drugs."