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    Thursday, July 22, 2004

    Costs vs. Benefits: Something interesting happened this week in the New England Journal of Medicine. Not only did it publish a study showing a new approach to colon cancer chemotherapy prolongs survival, but they also published an accompanying article calling into question its cost (requires subscription):

    The combination of irinotecan and cetuximab for second- and third-line treatment of metastatic colorectal cancer, as described by Cunningham et al. in this issue of the Journal (pages 337–345), increases the median survival by 1.7 months. In the United States, the regimen costs approximately $30,790 for an eight-week course. Assuming that an average patient continues to receive treatment until the median time to progression, 8 months of front-line therapy followed by 4.1 months of irinotecan–cetuximab therapy would cost $161,000.....These cost estimates are exclusively for drugs; they do not include the costs of preparation, administration and supervision, or supportive medications. They presume that every single milligram of drug is effectively utilized. Yet cetuximab, for example, is manufactured only in a 100-mg vial, and because the medication cannot be stored for long periods, leftovers go to waste, particularly in small practice environments.

    ....The Centers for Medicare and Medicaid Services (CMS) has made decisions about coverage on the basis of the "reasonable and necessary" clause in the original statute that established Medicare in 1965. There has been no political will to deny coverage for effective interventions on the basis of cost. The public has engaged very little in the deliberations used to reach influential decisions about Medicare coverage.

    And as a result, the majority of the media coverage of the study has been more critical than it would have been. Instead of getting headlines that exaggerate the positives of the study, we're getting much more accurate headlines like this. Kudos to the Journal for finally raising the issue. They should do this in every issue - examine honestly the cost as well as the benefit of the therapies that are being touted in its pages.

    On the Other Hand: The article dealing with the cost of the drug puts most of the blame on the pharmaceutical industry and implies that there should be price controls on drugs. I suppose that would be one way to reduce costs. Make it unprofitable for them to develop the drugs in the first place. But clearly, the real focus of the debate should be on whether or not theses sorts of drugs are worth their price in the first place. Few people would be willing to spend $30,000 of their own money for one and half more months of sickness. Why are we so willing to spend someone else's money for it? And why would doctors recommend it?

    posted by Sydney on 7/22/2004 10:15:00 AM 0 comments


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