Memorial Sloan-Kettering Cancer Center made a very public announcement—and explanation—today in a New York Times op-ed about why they will not offer the new drug Zaltrap® (ziv-aflibercept) to its metastatic colorectal cancer patients.
The authors, all world-renowned cancer specialists at the world’s oldest cancer center, in an op-ed headlined “In Cancer Care, Cost Matters,” essentially challenged other cancer centers to take action where politicians fear to tread.
“We recently made a decision that should have been a no-brainer,” wrote Drs. Peter B. Bach, Leonard B. Saltz and Robert E. Wittes. “The drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price—at $11,063 on average for a month of treatment—is more than twice as high.”The FDA approved Zaltrap in August for use in metastatic colorectal cancer (mCRC). Both Zaltrap (marketed by Sanofi and Regeneron) and Avastin® (bevacizumab, marketed by Genentech) work through a similar molecular mechanism, and when either medicine is added to standard chemotherapy, “either medicine has been shown to prolong patient lives by a median of 1.4 months.”
(Note: the authors disclosed that two of them–Drs. Bach and Saltz–have received consulting fees by Genentech.)
“In most other industries, something that offers no advantage…yet sells for twice the price would never even get on the market,” they wrote. But health care is not like other industries. Medicare, as well as private insurers in most states, are required to cover a new drug once it receives FDA approval. But the FDA can only consider whether a new drug is “safe and effective”—not more effective, and costs cannot be considered by either the FDA or Medicare.
The Memorial Sloan-Kettering Cancer Center leaders noted that their seemingly rational decision to use the less expensive, equally effective drug would likely be called “rationing, not rational” in a culture where no politicians seem willing to address rising costs of cancer.
“But if no one else will act, leading cancer centers and other research hospitals should,” they challenged their peers. “The future of our health care system, and of cancer care, depends on our using our limited resources wisely.”
Colorectal cancer is typically diagnosed in older people covered by Medicare, which requires a 20 percent copayment for drugs. An older person without supplemental Medicare insurance would have to pay more than $2,200/month for Zaltrap—which is more than the total monthly income for half of Medicare participants. Avastin would cost about $1000 a month.
The medical world already buzzing
Respected health economist Vivian Ho, the James A. Baker III Institute Chair in Health Economics at Baylor College of Medicine and economics professor at Rice University quickly weighed in with her approval.
The Oct. 15th issue of ClinicalOncology News (an online newsletter for physicians), published a related report about how researchers and doctors’ discussions about both benefits and costs of new drugs can confuse patients, community oncologists, and yes, politicians.
You’ll likely see other mass media covering this decision by Memorial Sloan-Kettering Cancer Center, such as this Washington Post blog.
What this means for patients:
In the current American medical system and political climate, it’s up to the individual patient and oncologist to seriously discuss the real costs and benefits especially about new drugs becoming available for metastatic CRC.
Stay tuned: Fight Colorectal Cancer will continue monitoring the medical and political worlds, as well as agencies such as Medicare and insurers making coverage decisions.
Disclosure: Fight Colorectal Cancer has accepted funding for projects and educational programs from sanofi-aventis and Genentech in the form of unrestricted educational grants. Fight Colorectal Cancer has ultimate authority over website content. See the Fight Colorectal Cancer Funding Policy and Disclosure.