The real cancer killer: rip-off drugs

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Glivec reuters REUTERS A man buys cancer drug Glivec for a relative who is suffering from cancer at a pharmacy in a government-run hospital in the western Indian city of Ahmedabad.

London - An influential group of cancer experts has warned that the high prices charged by pharmaceutical companies for cancer drugs are effectively condemning patients to death.

The group of more than 100 leading cancer physicians from around the world, including nine from the UK, accuse the drug industry of “profiteering” and say they will now campaign to force drugs companies to cut their profit margins.

“What determines a morally justifiable price for a cancer drug?” the specialists ask. “A reasonable drug price should maintain healthy pharmaceutical industry profits without being viewed as 'profiteering'.”

Of the 12 drugs approved by the Food and Drug Administration in the US in 2012, 11 were priced above $100,000 (about R900 000) per patient per year. The price of existing drugs of proven effectiveness has been increased by up to threefold.

These high prices mean the drugs may not be approved in the UK by the National Institute for Clinical Excellence (Nice), forcing doctors to fill in a 14-page application to the Cancer Drugs Fund for British patients who could benefit from them.

The rising cost of drugs in a cash-limited health service such as the NHS also means that treatment is denied to patients with other conditions.

The authors of the article, published in the journal Blood, are all specialists in blood cancers such as leukaemia, where cancer drugs have proved most effective. One of the best known - imatinib, whose brand name is Glivec - has proved so successful in chronic myeloid leukaemia that patients who a decade ago survived for a few years can now look forward to a near-normal life expectancy.

But the cost of Glivec has risen from £18,000 per patient per year to around £21,000 in the UK and from $30,000 to $92,000 in the US.

This is despite the fact that all research costs were covered by the original price, and the number of patients treated and the length of time they are on the drug have both vastly increased because of the drug's success.

“Of course we need the pharmaceutical industry to go on developing new drugs,” said Professor Jane Apperley, chair of the Department of Haematology at Imperial College, London, one of the authors. “It is very exciting that a number of cancers are now becoming susceptible to these new drugs. But the rising cost is unsustainable.

“The drugs are very effective at keeping people alive. But if they are priced out of what you can afford you know that you can keep people alive but you can't afford to do so.”

She added: “The price of a drug heavily influences the decision of Nice whether we can prescribe it on the NHS. I am chief of service at Imperial College and we are constantly being asked to reduce our spending. We have to look very carefully at the cost of the drugs we use.”

Daniel Vasella, former chairman and chief executive of Novartis, the manufacturer, said the original price charged for Glivec in 2001 was considered “high but worthwhile” and was estimated to yield annual revenues of $900m, enough to cover its development cost in two years. A decade later its annual revenues in 2012 were $4.7bn.

The cancer specialists say the revenue earned by Glivec over the last 10 years “represents generous profits to the company”. But this has put heavy pressure on those who have to foot the bill. “Grateful patients may have become the financial victims of the treatment success, having to pay the high price annually to stay alive”. In the US even those with health insurance may pay an average of 20 percent of drug prices. Drug prices are the single most frequent cause of personal bankruptcies in the US.

Three new drugs have been approved for chronic myeloid leukaemia in the last year by the FDA but the prices are “astronomical”, the authors say, at up to $138,000 a year per patient.

Worldwide only about a quarter of the patients with chronic myeloid leukaemia who could benefit have access to drugs because of the cost. “A small fraction are rich enough to pay individually, and most are treated intermittently or not at all. The effects of these financial pressures on long-term survival … are yet unknown.”

The authors of the article in Blood conclude: “We believe the unsustainable cancer drug prices may be causing harm to patients. Advocating lower drug prices is a necessity to save the lives of patients who cannot afford them.” The group says it intends to campaign for lower cancer drug prices.

A spokesperson for the charity Leukaemia and Lymphoma Research said: “As a charity we want to see an ethical approach to drug pricing. There is no point in us investing in research if the pricing policy means drugs won't be available to patients.”

In a statement to The Independent, Novartis said: “We recognise that sustainability of healthcare systems is a complex topic and we welcome the opportunity to be part of the dialogue. Our critical role, as one of many parties working towards improving cancer care, is to discover and develop innovative treatments.

“Novartis's innovation in chronic myeloid leukemia [CML] has changed the course of the disease. Before Glivec and Tasigna, the five-year survival in CML was only 30 percent. Today, nine out of 10 patients with CML have a normal lifespan and are leading productive lives.

“Over the years, our programmes have evolved to improve patient access to our medicines. We work together with government healthcare systems, charities and other payers to build successful cost-sharing models.”

 

 

EXPERT VIEW

'Price of drugs is harming patients'“

The following is an extract from an article, contributed to by more than 100 leading cancer physicians from around the world, including nine from the UK, published in the journal, Blood.

“This perspective reflects the views of a large group of CML experts, who believe the current [high] prices of drugs may compromise access of needy patients to highly effective therapy, and are harmful to the sustainability of our national healthcare systems...

If drug price reflects value, then it should be proportional to the benefit to patients in objective measures, such as survival prolongation, degree of tumour shrinkage, or improved quality of life. For many tumours, drug prices do not reflect these endpoints, since most anti-cancer drugs provide minor survival benefits, if at all.

As physicians, we… believe the unsustainable drug prices in CML and cancer may be causing harm to patients. Advocating for lower drug prices is a necessity to save the lives of patients who cannot afford them … For CML, and for other cancers, we believe drug prices should reflect objective measures of benefit, but should also not exceed values that harm our patients and societies.” - The Independent



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