http://www.nytimes.com/...
The above article, published in the New York Times April 25, references a paper showing that the costs of leukemia drugs are actually harming patients. The paper, authored by Dr. Hagop Kantarjian, Professor of Medicine and Chair of the Leukemia Dept at MD Anderson, and signed by 120 leukemia specialists, was published in the journal "Blood," is still reverberating in the world of medicine and beyond. Yesterday Medscape, a popular professional portal for physicians, sent out a mass e-mail consisting of the following quartet of articles:
Special Report: High Cost of Cancer Care
From Medscape Oncology
1. Cancer Cost: 'Number-One Healthcare Issue' by Zosia Chusteka
2. Bankruptcy or Cure? A Cancer Patient's Dilemma by Bruce Chessen, MD
3. New Adverse Event in Cancer Treatment: 'Financial Toxicity' by Nick Mulcahy
4. Bankruptcy Rate Doubles With Cancer Diagnosis by Nick Mulcahy
I was shocked to see this because I always thought that Medscape was a lackey to Big Pharma, and I always took what is published there with a grain of salt. But here we have national experts talking about the very real concept of "financial toxicity!" Hallelujah! In the first article Dr. Kantarjian is interviewed and says they found a substantial percent (10%) of chronic myelogenous leukemia patients fail to take their drugs largely because of cost. This is a drug they need to take on a long term basis or they will die. The cost of new cancer drugs has skyrocketed from <$5,000/yr before 2000 to over $100,000/yr. The drug companies say it costs $1 billion to develop a new cancer drug, but Kantarjian says this is myth. It costs no more than 10% of that, and they recoup their costs quickly. Despite having already recouped their costs years ago, this past January the makers of imatinib, raised their price overnight from $25,000/yr to $90,000/yr over the angry cries of patients and doctors alike. The article documents the huge variation of prices of these drugs in different countries with the US having 50-100% higher prices than the next most expensive country. It describes the 10 year survival for chronic myelogenous leukemia is 80% in Sweden, where they have no out of pocket costs, whereas here where patients have to pay a portion of the costs it is 60%. Dr. Kantarjian says he has learned there may be Congressional hearings as a result of his paper. More below
It was gratifying to see the video of Dr. Bruce Chessen of Georgetown U in the second article. He discusses the importance of the Kantarjian paper as one that is not only important but "commands respect." The world needs to pay attention to it. He describes his own outrage after a drug he worked on, Pentostatin, which was developed and tested entirely with taxpayer funds through all 3 trial phases, was taken over for commercialization by a company that charged astronomical sums despite their development costs being zero. He talks about the MORAL implications of drug prices. As for a solution? Chessen would "hate the government to step in" and would rather doctors, patients and industry "deliberate." (Ya right. Because drug companies are such moral entities and are capable of being shamed.)
The third article by two doctors from the Duke Cancer Institute discusses that financial burden affects well-being, and that, despite what drug companies would have you believe, cancer patients are paying a lot more for treatment than in the past, even when insured. We all pay more in increased premiums and higher copays. Then cancer patients have high out of pocket copays for the drugs, for outpatient care, and for hospitalization. Indebtedness is common, and in one study, " and 19% believed that the cost of treating their disease caused their family a large amount of distress (J Oncol Pract. 2010;6:69-73)." The authors suggest including cost-effectiveness in clinical guidelines as well as making costs of all drugs and services transparent to patients and doctors alike.
The fourth article looks at Scott Ramsey, MD, PhD's analysis of bankruptcy rates of cancer patients in Western Washington. Cancer patients are 2.65x more likely to file than non-cancer patients. Furthermore, patients younger than Medicare are 2-5 times more likely than >65 yo to file . A bankruptcy expert says younger patients may lose coverage if they have to stop work and she says that the number filing in any one year is a tip of the iceberg of financial distress.