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Rising costs of cancer treatments not matched by clinical efficacy Posted 03/03/2017

The high prices of new cancer treatments are a major barrier to access in low-income countries and placing growing pressure on developed countries. In their study, author Hill et al. estimated the lowest possible treatment costs for four new cancer drugs, showing that manufacturing of generics alternatives could significantly reduce treatment costs [1].

As people live longer and lifestyles are changing – poor diets causing rising rates of obesity for example – the incidence of cancer is increasing. Globally, there were over 14 million new cases in 2012. By 2035, this figure is expected to rise to almost 24 million.

This comes at a high social and economic cost. The worldwide cost of newly diagnosed cancer cases is at least US$286 billion, as estimated in 2009. Since then, several new classes of drug have entered the market, many at unprecedented high prices.

The pricing of cancer treatments is a known barrier to access in low- and middle-income countries, where it is not unusual for the monthly cost of a drug to surpass annual salary. This is especially problematic as the majority of new cancer cases are occurring in these countries, as lifestyles are rapidly changing.

But this is not only a problem for the developing world, high-income nations are also suffering from the rising prices of cancer drugs. In the UK, for example, the average cost of cancer treatment increased 10-fold in the 10 years since 1995. Indeed, across Europe, the price of cancer treatments is contributing disproportionately to the overall cost of cancer care. 

What is more, the increased spending does not appear to be generating clinical benefit. Assessments of the efficacy of anticancer agents show little correlation with cost. Of the 12 oncology drugs approved by the US Food and Drug Administration (FDA) in 2012, the majority were priced at over US$10,000 per month, yet only three prolonged survival. In the UK as well, the National Institute for Health and Care Excellence (NICE) frequently finds new cancer medicines to be ‘cost-ineffective’. Since 2000, over 30% of all appraisals conducted by NICE for cancer drugs came out as ‘not recommended’.

A study published at the end of 2016 [1] set out to analyse cancer treatments deemed cost-inefficient in England. The UK scientists estimated the impact of using generic alternatives for four anticancer drugs, three of which were defined as cost-ineffective by NICE but are still funded through the contentious Cancer Drugs Fund (CDF). The CDF helps patients in England get cancer drugs that are not routinely available on the National Health Service (NHS), but has been criticized for rewarding ‘poor quality’ drugs.

The researchers generated target costs for bortezomib, dasatinib, everolimus and gefitinib using a production cost algorithm. They also estimated the lowest available generic drug price, patent expiry dates and total eligible treatment populations for the drugs.

A more detailed discussion of the results is presented in the following two articles.

Conflict of interest
The work of the research paper [1] was supported by an unrestricted research grant from MetaVirology. MetaVirology had no editorial control over the final report. The authors of the research paper [1] declared no competing interests.

Editor’s comment

Readers interested to learn more about generic oncology drugs are invited to visit www.gabi-journal.net to view the following manuscripts published in GaBI Journal:

Generics and off-patent biologicals for cancer treatment in developing countries

Oncologists urged to embrace biosimilars to help control spiraling costs of cancer care

Impact of breast cancer generics in Europe

Readers interested in contributing a research or perspective paper to GaBI Journal – an independent, peer reviewed academic journal – please send us your submission here.

1. Hill A, Redd C, Gotham D, Erbacher I, Meldrum J, Harada R. Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis. BMJ Open. 2017;7:e011965.

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