Oncologists explain in an article for the journal Mayo Clinic Proceedings that the increasing costs of cancer drugs are affecting care of cancer patients in the US.
Dr. S. Vincent Rajkumar, of Mayo Clinic Cancer Center in Rochester, MN, and his colleague Hagop Kantarjian, of The University of Texas MD Anderson Cancer Center in Houston, report that the average price of cancer drugs was $5,000 to $10,000 for 1 year of treatment before 2000. By 2012, however, the cost of drugs for 1 year of treatment had rocketed to more than $100,000.
Over the same period, note the authors, the average household income in the US fell by about 8%.
"Americans with cancer pay 50% to 100% more for the same patented drug than patients in other countries," says Dr. Rajkumar. "As oncologists we have a moral obligation to advocate for affordable cancer drugs for our patients."
The pharmaceutical industry justifies the high prices of cancer drugs with the rationale that conducting research and developing drugs is expensive.
Also, the industry expresses a belief that market forces will result in prices settling to "reasonable levels" and rejects calls for placing price controls on cancer drugs, claiming that such policy would "stifle innovation."
These arguments are rebutted by Dr. Rajkumar:
"One of the facts that people do not realize is that cancer drugs for the most part are not operating under a free market economy. The fact that there are five approved drugs to treat an incurable cancer does not mean there is competition. Typically, the standard of care is that each drug is used sequentially or in combination, so that each new drug represents a monopoly with exclusivity granted by patent protection for many years."
What can be done to slow the rise of cancer drug costs?
Legislation that prevents Medicare from negotiating drug prices is a factor involved in driving up the costs of cancer drugs, and the authors suggest that this legislation should be redrafted to allow price negotiation.
The oncologists also cite a lack of value-based pricing - where the cost of a drug is linked with its relative effectiveness compared with other drugs - as another driving factor. Allowing the Food and Drug Administration (FDA) to recommend target prices based on a drug's magnitude of benefit could help to remedy this, the authors say, in addition to implementing guidelines that incorporate the cost and benefit of cancer drugs.
Drs. Rajkumar and Kantarjian look to other developed countries for potential solutions for controlling and reducing the high cost of these drugs.
Their recommendations include eliminating "pay-for-delay" strategies, where pharmaceutical companies share profits on their brand name drug with manufacturers of generic variants for the duration of a patent period. This is a tactic used by pharma firms to prevent patent challenges and competition.
Cancer advocacy groups such as the Patient-Centered Outcomes Research Institute should be allowed to consider cost in their recommendations, suggest Drs. Rajkumar and Kantarjian, who also call for patient-driven grassroots movements and organizations to advocate the interests of cancer patients.
The oncologists also recommend that patients should be allowed to import drugs from other countries for their personal use.
A report published in the Journal of Clinical Oncology last year found that legislation passed in 2003 to slow the spiraling costs of cancer drugs used to treat Medicare patients has had "no meaningful impact."