The rising costs of cancer care

According to an article in USA Today, one in eight patients with advanced forms of cancer in the US are now turning down recommended forms of treatment because they can’t afford the cost (or perhaps they don’t think the cost is worth the benefit). The article also states that for families with a household income of $40,000 or less, one in four families come to this decision.

The article does not contain any information that is specific to prostate cancer. However, it seems likely that with the next generation of innovative drugs for treatment of castration-resistant prostate cancer, we will see many prostate cancer families placed in this position too (if they aren’t already).

Let’s look at the possible scenario for sipleucel-T (Provenge) and abiraterone, the two most promising drugs on the prostate cancer horizon, which could both be approved in the next few years. And let’s assume that the average survival benefit that these drugs might offer compared to current palliative care is 6 months (which would be a very significant clinical benefit).

If we compare the size of the “market” for these drugs to the size of the market for drugs like Herceptin (used to treat breast cancer) and Gemzar (used to treat pancreatic and lung cancers), it seems unlikely that either sipleucel-T or abiarerone is going to cost less than $50,000 for a course of treatment (and that’s probably a conservative guesstimate).

If you have insurance, and your insurance company provides even quite decent coverage, thay may pay for 80 percent of the cost of these drugs once they are approved. That means that the patient’s out of pocket costs for therapy with one of these drugs alone (exclusive of doctors’ fees, other drugs, etc.) would be about $10,000.

Are families going to be able to pay that sort of money for 6 months of additional life for Dad or Grandpa? Surely we’d all like to be able to do that, but can we really? And what will Grandpa himself have to say on the subject if he’s 87 and already can’t get out of the wheelchair?

This should help us all to understand that the US health care system is in need of a major overhaul. High quality drugs that provide high levels of patient benefit are bound to come at a price, but when does the price become too high? When 25 percent of the population can’t afford them? Or is it when 50 percent can’t? Or what? If it’s when 25 percent can’t afford them, we’ve probably already reached the limit, given that some 47 million Americans have no health insurance at all.

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