Steps can be taken to lower the cost of myeloma treatment, such as modifying the induction regimen or limiting maintenance to 1 or 2 years instead of 10 years. “You then save $150,000 per year,”
Myeloma chemotherapy drugs are expensive. No one denies this. The interesting thing about Dr. Rajkumar’s suggestions above, is that multiple myeloma patients can follow Dr. Rajkumar’s advice (modifying your induction regimen or limiting maintenance) right now.
The MM patient is in charge of his/her own body and therefore makes his/her own therapy decisions.
Consider a newly diagnosed MM undergoing several weeks of prehabilitation, including probiotics, curcumin, omega-3, others, increase the chance of achieving MRD negative status, and wait to have an autologus stem cell transplant. Studies show that achieving MRD neg. status leads to a longer overall survival regardless of ASCT.
If you want to undergo low-dose maintenance therapy at some point, you can save considerable amount of money on myeloma chemotherapy in two ways.
Consider reducing the recommended dose (say 5 mg. of revlimid, down from 10 or 20 mg.) and add evidence-based, non-toxic integrative therapy to increase the efficacy of Revlimid. Undergo low-dose maintenance therapy for months instead of years.
Studies cite how curcumin can enhance the efficacy of revlimid while reducing it’s toxicity.
The point is, if the newly diagnosed MM patient doesn’t think outside the MM box, he/she will pay the full price of conventional myeloma chemotherapy and may have little to show for the expense.
Have you been diagnosed with multiple myeloma? Scroll down the page, post a question or comment and I will reply to you ASAP.
Thanks,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
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“CHICAGO — Over the past few years, the approval of several new drugs for multiple myeloma, as well as evolving strategies for stem cell transplant, have contributed to increased survival and improved quality of life for many patients with this disease.
However, the new agents come with hefty price tags, and multiple myeloma has become a very expensive disease to treat. Can we afford it? Or not?
That was the debate between two experts at the recent annual meeting of the American Society of Clinical Oncology.
S. Vincent Rajkumar, MD, professor of medicine, Department of Hematology, at the Mayo Clinic School of Medicine, Rochester, Minnesota, argued that the cost of care is not affordable and that action needs to be taken.
“I don’t like this debate, and I don’t think that there is anything here to debate,” he said as he opened his talk. “It’s like debating whether the earth is flat or not — these drugs are expensive…”
“It is sad that when we wrote this paper, the US spending on cancer drugs was $25 billion, and in just 5 years from then, it is now $50 billion,” he said…
He went on to outline the magnitude of the problem.
In the United States, 30,000 patients were diagnosed with multiple myeloma in 2017. The total lifetime cost of treatment was $22.4 billion. This figure excludes spending on hospitals, nurses, infusions, imaging, physicians, laboratory studies, and other ancillary costs.
I should stop the debate here, because this is just not affordable.Dr Vincent Rajkumar
The problem is that the cost of the drugs is too high, he continued.
For 11 agents used in the treatment of myeloma, the cost ranges from a low of
- $5800 per year for cyclophosphamide (multiple brands) to a high of
- $192,000 per year for pomalidomide (Pomalyst, Celgene).
- Carfilzomib (Kyprolis, Onyx Therapeutics) is even more costly ($260,000) if it is given at a dose of 56 mg/m2.
However, the actual costs are even higher, because these drugs are not used as monotherapy but in combinations, often with two other drugs. Triple therapy runs from $220,000 to 300,000, depending on the combination, “and now we are hearing chatter about quadruplets,” he added. “Are we kidding?”
The price for quadruplet therapy could run from $340,000 to $500,000 per year, depending on the particular combination.
Rajkumar returned to the figure of $50 billion spent on cancer drugs in 2017.Of that figure, 80% is accounted for by only 35 drugs.Of those 35 drugs, six are for myeloma.Yet myeloma comprises just 1% of all cancers, he pointed out.The underlying problem is not just the cost myeloma drugs — it is the high cost of all new cancer drugs.
Each drug approved by the US Food and Drug Administration (FDA) in 2017 costs $100,000 or more, with an average cost of $150,000. In 2017, for the first time, five new drugs were priced $300,000 or more per year.
Rajkumar then put these prices into perspective. Given the fact that in the United States, the average household income is $52,000, it would take 10 people to support 1 year of life. The cost of drugs leads to problems with treatment adherence and bankruptcy.
The problems with cost are not just related to innovation. “It’s not just fancy new drugs that are being made with a lot of hard work and randomized trials,” he said. “It’s all drugs…”
Why Are Prices So High?
So all of this begs the question — why are prices so high? Rajkumar offered a few explanations.
First is the cost of drug development. Although estimates vary, ranging from $700 million to $2 billion, the bottom line is that it is a very expensive endeavor.
Second, he noted, is the seriousness of the disease. “If you or your loved one has cancer, you’re willing to do just about anything,” he said. “If I can’t afford it, if I need to sell my house, I will somehow get the money to pay for this drug.”
And third is the “blatant and occult patent evergreening.” The cost remains high as long as the drug remains on patent, but as the end of the protected period approaches, companies will do everything possible to delay patent expiration.
There are other problems with drug costs, some of which are unique to the United States. One is that Medicare cannot directly negotiate with pharmaceutical companies. But there are many others:
- there is a ban on personal importation;
- the reimbursement system gives higher fees to physicians who use more expensive treatments;
- there’s liberal off-label use;
- and there are also several middlemen between the payer and the pharmaceutical company,
all of whom profit from high prices.
Finally, there is also a lack of “allies.” He noted that many physicians have consulting agreements, serve on advisory boards, are on steering committees, and run clinical trials for industry. “They don’t want to take on pharmaceutical companies,” Rajkumar said.
Suggestions for Solutions
“This all sounds pretty sad or pretty distressing,” Rajkumar commented, but there are some solutions. He outlined several steps that can be taken, many of which have been proposed and discussed by others.
One example is the need for value-based pricing.
“A high list price regardless of the value that the drug provides is the enemy of innovation,” he commented. “If you can make money with a ‘me-too’ that prolongs life by an extra 1 week over the previous drug, why would you take the risk and develop a brand new compound that may fail in phase 3, and you’ve just burned $2 billion?”
- Another solution that has also been proposed is that
- Medicare needs to be able to negotiate prices.
- Another solution would be to permit personal reimportation, which would facilitate the entry of generics and biosimilars into the marketplace.
- Yet another would be to reduce the cost of new drug development.
On this last point, Rajkumar commented, “In our good intentions of making everything super, super safe, we have so many regulations so that every t is crossed and every i is dotted, to the point that it costs $30,000, $40,000 per patient to do a trial…
Rajkumar emphasized that physicians always want to give the best treatment, but with respect to myeloma, the best treatment may be just too expensive from the standpoint of both the patient and society. “So we may have to use the best possible option,” he said.
Steps can be taken to lower the cost of myeloma treatment, such as modifying the induction regimen or limiting maintenance to 1 or 2 years instead of 10 years. “You then save $150,000 per year,” he noted. “You could give consolidation and slow maintenance, and, in some places, transplant is really cheap compared to new drugs. In that case, transplant can be used more effectively.”
Another step that can be taken is to incorporate cost considerations into clinical guidelines, he said. Thus, for selecting a treatment regimen, guidance would not only be best in the medical sense but also in the economic sense. One example is zoledronic acid (Reclast, Zometa, Novartis) vs denosumab (Prolia, Xgeva, Amgen), both of which are used in the treatment of myeloma patients to prevent skeletal-related events, including fractures.
A recent trial showed the two drugs to be similar in efficacy, but there is a big price difference — $60 for zoledronic acid, and $2000 for denosumab — Rajkumar pointed out.
Conducting strategic trials is another approach. The endpoint may be not only improving survival but also cutting costs and improving quality of life…
Rajkumar ended his talk with a direct appeal to patients. “I understand that the last thing on your mind is to take on another battle to lower drug costs,” he implored, “but we need you. Other patients need you. More important, you need it for yourself. If drugs that hardly work for a month or two can be priced at a fortune, it detracts from true innovation.”
