Wednesday, March 25, 2015

BREAKING: cancer therapy prolongs survival 6 months, worth 2-3 billion/year

by: Alex Smith @AlexSmithMD

An article was published yesterday that provides supporting evidence that a treatment* for advanced cancer improves survival by up to 6 months (18 vs 12 months).  This study was conducted in a population of patients with advanced cancer who had a prognosis of less than 2 years.  The first, earlier study of this treatment* to examine survival demonstrated a survival benefit of about 3 months in advanced lung cancer.

This is big news folks. 

A major question for our society - can we afford this treatment*? 

By way of comparison, Avastin (bevacizumab) increases survival by about 4 months, about the same as the average survival benefit of this treatment*. Avastin had sales of about $2-3 billion per year at the time it was released.  The average cost for Avastin per patient is between $40,000-100,000 per course of treatment.

How much as a society are we willing to invest in a treatment* that improves survival by 4 months in advanced cancer?

*Treatment is early outpatient palliative care.  Costs of outpatient palliative care are generally offset by cost savings from reduced resource use (hospitalizations, emergency department visits).  Costs are likely minimal to negative.  If this was a drug it would be worth billions, and the US would pay for it.


Amy Getter, RN, MS said...

Like it or not, cost does matter. Just as disconcerting for many metastatic cancer treatments is the symptom burden. One must ask, was it worth it? My patient who just died 3 days ago told me "No", and she wished she had made a decision to stop treatment much earlier.

Joshua Uy said...

Wouldn't it be nice that if we were committed to spending this amount of money at the end of life for curative/therapeutic care that we would just give the money to the patient to use as they see fit? I have some ideas of what I would do with a spare $40,000-$100,000! Patients might spend the money more rationally than a paternalistic health system.

Anonymous said...

I am always conflicted by these studies. I understand and agree with them, and my dad would have fit the criteria for this study, as his colon cancer was stage IV and he was given at best 2 years.

However, he has been cancer free (or no evidence of disease) since 5/2009, and is now 85. We did add the supplement IP6 to his chemo (every patient with adenocarcinoma should take this), and the tumors, one in each lobe of his liver, were 95% dead when they were resected.

I understand though, that he was very lucky, and for everyone like him, there are many whose outcome has not been so positive, he is the exception and not the rule. Even though the chemo or surgery triggered parkinson's, he would do it all over in a heartbeat.


Christopher Langston said...

Isn't it early for April Fool's Day?

But I enjoyed your juxtaposition. I've used the same argument for years: for drugs and devices their is a tough path to coverage through FDA approval, but once you make it (and sometimes it isn't so tough), payment gets attached and things get added to the formulary.

For service innovations (like Palliative Care or collaborative care) there is no such pipeline to payment and therefore to scale. There are many roots of this barrier, but one is our social expectation of high tech solutions that come in a box, rather than systems re-engineering that changes how all the old boxes get used.

Is it too cynical to suggest that the system protects itself by refusing to pay for disruptive innovations?