More on the costs of new cancer treatments


As some of our regular readers will be aware, a new form of cancer therapy known as “chimeric antigen receptor T-cell” therapy (often known as CART or CAR-T) is currently in advanced stages of development. The “New” Prostate Cancer InfoLink believes that at least one form of CAR-T will be approved for the treatment of children with acute lymphoblastic leukemia (ALL)  — the most common childhood cancer — by the end of 2015, because outcomes using these types of treatment have proven to be extraordinary, with long-term remissions or actual disappearance of the cancer in about 90 percent of patients.

We have no idea (yet) whether CAR-T can be adapted for use in men with prostate cancer. We do know that the Prostate Cancer Foundation had been talking to Carl June at the University of Pennsylvania (one of the originators of CAR-T) as long as 2 years ago.

In today’s Wall Street Journal, there is a relatively brief but forthright article that includes discussion of the potential costs of such treatments once they are approved. And the number being run up the flagpole has been $500,000 or half a million dollars.

Now the first thing we have to realize is that maybe half a million bucks as a cost for a treatment that actually cures 80 to 90 percent of children ALL such that they live for another 60+ years is not an unreasonable cost — especially when you compare it to a figure of about $80,000 or $90,000 for a course of treatment with a drug like sipuleucal-T or abiraterone that extends the lives of prostate cancer patients by roughly a 3 or 4 months (and at best maybe 2 years).

On the other hand, what we don’t know yet (and probably won’t for a while) is just how effective and safe CAR-T therapies are over time. What is going to be the 10-year recurrence-free survival rate for these patients? What are going to be the long-term complications and side effects of a diagnosis of ALL and treatment with CAR-T therapy?

It does have to be said that $500,000 is of the same order of magnitude as the cost associated with a stem cell transplant — a common form of treatment for many patients with serious forms of hematologic cancer in adults (multiple myeloma, acute myelogenous leukemia, etc.), so we know that payers have covered such costs in the past.

On the other hand, at least one company (Pfizer, in conjunction with a French biotech company called Cellectis) is exploring the potential of a generic form of CAR-T therapy that could, possibly, be used to treat many forms of cancer patient, and thus lower the cost.

We’re just gonna have to wait and see how the efficacy and safety data — and then the economics — play out. It is worth remembering that, historically, the “value” of a human life has been estimated at $50,000 per annum in assessments of the valuation of treatments for patients with potentially life-threatening conditions. On that basis, if CAR-T can extend the life of a child with ALL by 10 years, then $500,000 is within the standard valuation assessment … but if it can extend the life of the child by 20 years, does that mean it is worth $1 million for a course of treatment? How do we make these decisions?

2 Responses

  1. Mike, I am thrilled to hear there might be a better treatment for childhood leukemia on the horizon. My niece was treated for this at age 2, and it wasn’t pretty. Chemo that wiped out her immune system followed by a bone marrow transplant. She is doing well at 19, but will probably not be able to have children. The half-million looks cheap to me.

    Here’s an interesting side note on how our government regulatory agencies price this when doing cost/benefit analysis on safety regulations. They use something called NCELS (net cost per equivalent life saved). The NHTSA uses a figure of about $6 million to proceed with a new regulation. Congress will pass laws having a much higher NCELS.

    Of course, when Congress or a regulatory agency enacts a safety regulation, they don’t actually have to find a way to pay for it. They just impose that cost by fiat on businesses, and ultimately all of us.

    I suppose it is good that the insurance companies have to be somewhat grounded in reality. They realize that, in the short term, their profits will be hurt, and longer-term insurance rates will have to rise. However, any realistic cost/benefit discussions in health care are going to sound pretty cold and scary. (Britain’s NICE is a pretty scary outfit.)

    Doug

  2. Doug:

    It’s interesting. As someone who grew up in England and is very familiar with the principles behind the National Health System (NHS), I don’t find NICE’s behaviors to be “scary” at all. To me they are just an inevitable fact of life for an organization (the NHS) with a fixed annual budget. You can’t pay for what you can’t afford and so you have to make simple and fair decisions about what you are willing to pay for. Anyone running a household budget understands that one.

    Does it mean that patients in England aren’t “entitled” in some way to be able to get every form of treatment that might theoretically be available to them? Sure it does, but the access or lack of access is the same for everyone whose health care is covered under the NHS. To that extent it is entirely fair — as opposed to the situation here in America, where what is available to you can be entirely dependent on what your employer may be willing to offer you as a health care plan (if any).

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