The study estimated the lowest possible treatment costs for four novel cancer drugs, selected based on their clinical importance, the innovative nature of their activity and the availability of data on generic drug prices. The scientists calculated the target costs for each drug using a production cost algorithm. Prices for the drugs were identified in 11 countries. The authors also considered patent expiry dates and total eligible treatment populations.

Bortezomib (Velcade)
Bortezomib, marketed as Velcade by Takeda Oncology, is used to treat multiple myeloma and mantle cell lymphoma. The drug can extend life expectancy by an average of six months over standard treatment but costs are around GBP 18,000 per patient. It was recommended against by the UK National Institute for Health and Care Excellence (NICE) in October 2006 due to cost issues. The lowest available generic drug price for bortezomib was GBP 199.92 per bottle, which was for an Indian generic drug.

Dasatinib (Sprycel)
This anticancer drug, marketed by Bristol-Myers Squibb (BMS), is approved for use in leukaemia and was also recommended against by NICE due to its high cost−benefit ratio. There is currently no generic version of this drug available in Europe. BMS is set to lose its patent protection on dasatinib in the EU by 2020.

The estimated price for dasatinib was GBP 9.43 per month and GBP 122.95 per year. The lowest available price for the drug was from the originator company (BMS) in Brazil, at GBP 769.03 per month.

Everolimus (Afinitor)
Everolimus is a derivative of the immunosuppressant rapamycin. It is marketed by Novartis and used to treat kidney cancer and types of pancreatic cancer. It has also been deemed cost-ineffective by NICE and is included on the Cancer Drugs Fund (CDF) list, which helps patients in England get access to drugs that are not available on the National Health Service. For off-label usage, the lowest available generic drug price was GBP 688.96 while for on-label use it was GBP 851.65. Both were for generic drugs produced by Indian firms.

Gefitinib (Iressa)
Marketed by AstraZeneca and Teva Pharmaceuticals, gefitinib targets the epidermal growth factor receptor and is used to treat types of lung cancer. It is the only drug of the four considered cost-effective by NICE, and has been recommended by the Institute as a treatment for people with advanced non-small cell lung cancer. The estimated price for gefitinib was GBP 10.26 per month, and GBP 133.73 per year. The lowest available generic drug price was GBP 90.49 per month. The European patent on Iressa is set to expire in May 2017.

Overall, these findings suggest that significant price reductions can be achieved for new cancer drugs in England though the increased use of generic versions. Generic production could reduce the UK price of dasatinib and gefitinib by over 99%, while importing generic versions of bortezomib and everolimus from India could lead to price decreases of over 70%.

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. 

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Reference
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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