The cost of cancer treatment

There’s been a lot of news lately about the cost of the new cancer drugs. Just yesterday, US Today ran an article on the subject, specifically citing the new targeted colorectal cancer treatments:

Effect of drugs on patients who have advanced colorectal cancer:

For drugs available in 1996
Total cost: $500
Expected survival: 11 months

For drugs available today
Total cost: $250,000
Expected survival: 24 months

Source: Leonard Saltz, Memorial Sloan-Kettering Cancer Center

It comes down to a simple question: is a single year of life worth $249,500? Depends on the life. When it’s someone you love, or yourself, there’s no dollar value. It’s priceless. I often say that my father died in 1999 when Emily was just 6 months old. If he had lived another year, he’d see her walking, she might have even called him “Poppy” the way Laini did. Laini was 3 when he died. She has llittle to no real memory of him, other than what she sees in pictures and what I tell her. Another year, and she would have a clearer picture of him in her mind’s eye. Would I have mortgaged my house and soul for $249,500 to have that? You bet. Without taking time to blink.

But stepping back and looking at the issue from a bigger perspective, and it’s a much tougher question. It’s a crippling amount of money, for both the patient and the insurers. Erbitux, another colon cancer drug, won’t even be available in Canada at all over pricing issues. Pharmaceutical companies have to make money, sure, but I don’t think they’re being as profit-hungry as one would assume. These targeted therapies, which attack very specific cells in very specific ways are simply very, very expensive to develop. Far more expensive than the standard “kill everything that lives” chemotherapy.

“These costs are out of control,” says Fran Visco, president of the National Breast Cancer Coalition, which is planning a conference focused on drug costs in the fall. “We can’t allow it to continue.”

It’s a noble sentiment, but seriously…where is the solution? It takes research to develop these drugs, test them and bring them to market. Maybe pharmaceutical companies should disclose exactly how much it cost to develop, test and bring a drug to market, then set a cap on the profit outside of that. Articles make it seem like if Avastin is $4,000 a month, $3,995 of that is profit for the drug company. I don’t think the margin is that wide.

We’re in uncharted territory here. Cancer used to be a death sentence. Now people are living longer and even beating it. How can we determine how much is too much if we’re just starting to win a battle that we barely started fighting? No precedent to say that 10 years ago we cured a case of colon cancer for $5 and now it costs $5,000 because 10 years ago that person died without having any option of treatment like there is today. Part of the debate centers around the fact that these drugs for metastatic disease aren’t curing cancer, they’re just prolonging life. True. But most cancer patients say that every day they wake up is another victory. Aren’t we all just prolonging life until our death? Who’s to say how much time is worth it…is it one year? 5? 10? 25? 50? Who gets to plays God and set that number of how much time of additional life is enough to make it worth the cost?

It all comes back to the prevention message. The cheapest way to fight colon cancer is to not get it in the first place. Which is more cost effective for the employer or insurance company, the $2,500 colonoscopy once every 10 years or $10,000 per month for a year on Erbitux?

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