News
OncologyPractice.com asked editorial advisers to The Oncology Report and Community Oncology the following question.
• Sanofi has cut the price of ziv-aflibercept (Zaltrap) in half after oncologists at Memorial Sloan-Kettering Cancer Center in New York refused to prescribe the drug because of its high cost. Do you see this as a "watershed moment," as Dr. Lee Newcomer of UnitedHealthcare suggests in the New York Times? What impact will this have on efforts to contain the cost of cancer care?
Their comments follow.
Urologists Question Cost-Effectiveness of New Agents for Prostate Cancer
Dr. Judd W. Moul
James H. Semans, MD Professor of Surgery
Director, Duke Prostate Center
Division of Urologic Surgery
Duke University Medical Center
Durham, N.C.
Associate editor, The Oncology Report
As a urologist/urologic oncologist, I am not able to comment specifically about Zaltrap and the cost-effectiveness of this agent. However, with regard to prostate cancer, our field has seen six new FDA approvals over the past 2.5 years (Provenge, Jevtana, Xgeva, Prolia, Zytiga, and Xtandi) that are all more expensive than our prior, more limited options.
Dr. Judd W. Moul
In particular, much has been written about the $93,000 price tag of Provenge and its novel but unfamiliar mechanism of action that does not lower PSA but does result in a median 4.1-month overall survival benefit. I do not want to pick on Provenge, because the new oral antiandrogen enzalutamide (Xtandi) is priced at about $7,500 per month. While medical oncologists seem to be more used to and accepting of these prices, many urologists are not as accustomed to these costly agents and have questioned their cost-effectiveness.
Add to this the common misconception that prostate cancer is an "old man’s disease" and somehow these lives are not as valuable. And, the constituency of men is not as health-savvy or vocal as other groups, and we may have a watershed moment for the disease that I have spent a career trying to impact.
Interestingly, as a surgeon, I am amazed that no one has stopped paying for the extra costs of robotic prostatectomy, even though the proven benefit over more traditional and less expensive open surgery is even more suspect than these novel pharmaceuticals.
A ‘Wake-up Call’ That the Free Market System Will Not Work for Cancer Drugs
Dr. Malcolm J. Moore
Daniel E. Bergsagel Professor of Medical Oncology
Head, Division of Medical Oncology and Hematology
Princess Margaret Cancer Centre, UHN and Mount Sinai Hospitals
Toronto
Associate editor, The Oncology Report
Dr. Malcolm J. Moore
The costs of new cancer drugs are driven not by value but by ability to charge. Cisplatin was introduced in 1978, costs less than $100 a month, and cures the majority of patients with advanced testicular cancer. How much would it cost if introduced in 2012? Every year, the monthly cost of new therapies reaches new stupefying levels, with regulators, oncologists, and payers seemingly unable to manage or control the system. Only a plutocrat could manage to personally pay for therapy, but collectively we all share the costs through our taxes and our insurance premiums.
Dr. Bach, Dr. Saltz, and Dr. Wittes [of Memorial Sloan-Kettering Cancer Center] deserve acclaim for taking a stand on Zaltrap, but one has to acknowledge that this was a drug that has little incremental value where other alternatives exist. The more difficult decisions will occur when breakthrough drugs arrive for the common cancers. So let’s view this episode as a wake-up call that the "free market" system will not work for cancer drugs. The regulators need to take the initiative in establishing a pricing framework that is sustainable for patients, payers, and industry.
Reversal Represents Success in Moving Toward Value-Based Systems of Care
Dr. Debra Patt
Texas Oncology
Dr. Debra Patt
Medical Director, Healthcare Informatics
Medical Director, Pathways Task Force
The US Oncology Network, McKesson Specialty Health
Editor, Community Oncology
Sanofi’s decision certainly represents a response to the oncology community pushing back on price. It represents a success in moving toward value-based systems of care, for Memorial Sloan-Kettering Cancer Center and others. Within the US Oncology Network, we are pleased with Sanofi’s response and know that it will translate into real value for patients and payers. Better value is paramount to the way we practice medicine as community oncologists who participate in level 1 evidence–based pathways to provide value-based care.
First-In-Class Drug Prices Will Be More Difficult to Challenge
Dr. Howard A. Burris III
Chief Medical Officer
Executive Director, Drug Development Program
Dr. Howard A. Burris