Curing cancer ain't cheap!

Greenbeard · Dec 15, 2017

A couple months ago the FDA approved a new treatment for certain types of cancer. A little background on it:

CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers

For years, the foundations of cancer treatment were surgery, chemotherapy, and radiation therapy. Over the last two decades, targeted therapies like imatinib (Gleevec®) and trastuzumab (Herceptin®)—drugs that target cancer cells by homing in on specific molecular changes seen primarily in those cells—have also cemented themselves as standard treatments for many cancers.

But over the past several years, immunotherapy—therapies that enlist and strengthen the power of a patient’s immune system to attack tumors—has emerged as what many in the cancer community now call the “fifth pillar” of cancer treatment.

A rapidly emerging immunotherapy approach is called adoptive cell transfer (ACT): collecting and using patients’ own immune cells to treat their cancer. There are several types of ACT (see “ACT: TILs, TCRs, and CARs”), but, thus far, the one that has advanced the furthest in clinical development is called CAR T-cell therapy.

Until recently, the use of CAR T-cell therapy has been restricted to small clinical trials, largely in patients with advanced blood cancers. But these treatments have nevertheless captured the attention of researchers and the public alike because of the remarkable responses they have produced in some patients—both children and adults—for whom all other treatments had stopped working.

In 2017, two CAR T-cell therapies were approved by the Food and Drug Administration (FDA), one for the treatment of children with acute lymphoblastic leukemia (ALL) and the other for adults with advanced lymphomas. Nevertheless, researchers caution that, in many respects, it’s still early days for CAR T cells and other forms of ACT, including questions about whether they will ever be effective against solid tumors like breast and colorectal cancer.

Essentially you hand some of your white blood cells over to a drug company which engineers them to kill certain cancers, and then they're put back into you.

It's not the most pleasant of processes but it seems to have pretty impressive results.

The only snag is, somebody has to pay for it.

Months After Approval, Breakthrough Cancer Drug Given to Just Five Patients

Two months after Gilead Sciences Inc.’s breakthrough treatment was approved in the U.S. to treat a deadly form of blood cancer, only a tiny handful of patients have actually gotten the costly therapy, while others linger on waiting lists.

Five people have received the treatment, called Yescarta, at the 15 cancer hospitals authorized to administer it in the U.S., the hospitals told Bloomberg. Waiting lists for the $373,000 treatment have grown to at least 200 people, shrinking only as some very sick patients have died.

Doctors at the cancer centers blame holdups in getting the treatment paid for by Medicare and Medicaid, the two giant U.S. government health programs, as well as some of the U.S.’s largest insurers.

Those payment delays -- which may not be resolved for months -- have forced the hospitals to choose between putting millions of dollars at risk, or asking dying patients to keep waiting despite the availability of a potential cure.

Private insurance companies are making coverage decisions for Yescarta on a case-by-case basis, while the Medicare program for the elderly hasn’t created a reimbursement code for the treatment -- meaning hospitals don’t have any guarantee they’ll be paid.

The whole thing costs the hospital (or at least the few currently equipped and authorized to provide this service) a lot more than just the $373K sticker price to buy the cell engineering itself, there are potentially hundreds of thousands of additional dollars in costs for hospitals added on to that, not only in preparing for and administering the treatment once they send/get back from the drug company the cells but also in dealing with the toxicity to the patient of the process.

It's a (morbidly) interesting ethical dilemma. The people in line for this treatment are at the end of their rope, but no hospital can afford to give away a half million dollars or more of care per case without knowing if anyone is going to reimburse them for it.

Carjosse · Dec 15, 2017

But waiting lists and people dying from not receiving the care they need never happens in the US. /s

Bum · Dec 15, 2017

I would be interested to see the actual cost breakdown.....how they arrived at that number, and why over time the cost isn't dropping.

Superfly · Dec 15, 2017

Greenbeard said:
A couple months ago the FDA approved a new treatment for certain types of cancer. A little background on it:

CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers

Essentially you hand some of your white blood cells over to a drug company which engineers them to kill certain cancers, and then they're put back into you.

It's not the most pleasant of processes but it seems to have pretty impressive results.

The only snag is, somebody has to pay for it.

Months After Approval, Breakthrough Cancer Drug Given to Just Five Patients

The whole thing costs the hospital (or at least the few currently equipped and authorized to provide this service) a lot more than just the $373K sticker price to buy the cell engineering itself, there are potentially hundreds of thousands of additional dollars in costs for hospitals added on to that, not only in preparing for and administering the treatment once they send/get back from the drug company the cells but also in dealing with the toxicity to the patient of the process.

It's a (morbidly) interesting ethical dilemma. The people in line for this treatment are at the end of their rope, but no hospital can afford to give away a half million dollars or more of care per case without knowing if anyone is going to reimburse them for it.

Interesting post. Thanks.

The cynical side of me has said for years that there was a cure, but it wouldn't be offered because it would put oncologists out of work.

Signed,
The wife of a 2-time cancer survivor.

Greenbeard · Dec 15, 2017

Carjosse said:
But waiting lists and people dying from not receiving the care they need never happens in the US. /s

In fairness, there may not be waiting lists for this treatment anywhere else on earth.

US regulators on Wednesday approved the first gene therapy against cancer - a treatment that uses a patient's own immune cells to fight leukemia - opening a new era in the fight against one of the world's top killers. . .

"This marks the first-ever CAR-T cell therapy to be approved anywhere in the world," Novartis CEO Joseph Jimenez told reporters on a conference call.

That's not necessarily a good thing for folks not in the U.S.

mike2810 · Dec 15, 2017

Carjosse said:
But waiting lists and people dying from not receiving the care they need never happens in the US. /s

In an ideal world, what you said would be true. That is not reality. Like the OP stated, someone has to bear the cost. So who do you think should pay for it?

I saw a show on TV (First In Human) that covered this treatment and others. It was very interesting. My opinion one needs to look at the cost of treatment vs what is it really buying for the future of the patient. Is the treatment only going to give a few years more of life? Is the quality of life going to be good or it is going to be fair/poor?

Carjosse · Dec 16, 2017

Greenbeard said:
In fairness, there may not be waiting lists for this treatment anywhere else on earth.

That's not necessarily a good thing for folks not in the U.S.

I was making fun of the people who say that the US system is better because there are no waitlists are people always get the treatment they need. As this illustrates that is not the case, care is going to whoever can pay for it not who needs it most.

Carjosse · Dec 16, 2017

mike2810 said:
In an ideal world, what you said would be true. That is not reality. Like the OP stated, someone has to bear the cost. So who do you think should pay for it?

I saw a show on TV (First In Human) that covered this treatment and others. It was very interesting. My opinion one needs to look at the cost of treatment vs what is it really buying for the future of the patient. Is the treatment only going to give a few years more of life? Is the quality of life going to be good or it is going to be fair/poor?

A single-payer system, it doesn't have to care about that cost for now it can focus on getting to the people who need it most.

ttwtt78640 · Dec 16, 2017

Carjosse said:
A single-payer system, it doesn't have to care about that cost for now it can focus on getting to the people who need it most.

That (bolded above) is still not everyone which makes it necessary to establish priorities or revert to a lottery system. In either case, there will remain the option for those that have the financial means to jump the line.

mike2810 · Dec 16, 2017

Carjosse said:
A single-payer system, it doesn't have to care about that cost for now it can focus on getting to the people who need it most.

Ok. you seem to be for the single-payer system. Therefore all individuals signed up would pay for the treatment through premiums. Under your solution, wouldn't premiums go up each year as expenses rise for the insurance company (or govt run single pay system)?

The costs are going to be covered somehow.

ttwtt78640 · Dec 16, 2017

mike2810 said:
Ok. you seem to be for the single-payer system. Therefore all individuals signed up would pay for the treatment through premiums. Under your solution, wouldn't premiums go up each year as expenses rise for the insurance company (or govt run single pay system)?

The costs are going to be covered somehow.

The costs are also going to be limited somehow. That part of the debate is very important to those that lack the financial means to jump the line. Just as "free" college does not mean universal college - having "free" cancer treatment does not mean universal cancer treatment.

Carjosse · Dec 16, 2017

mike2810 said:
Ok. you seem to be for the single-payer system. Therefore all individuals signed up would pay for the treatment through premiums. Under your solution, wouldn't premiums go up each year as expenses rise for the insurance company (or govt run single pay system)?

The costs are going to be covered somehow.

Well you use the power of bargaining to reduce the cost essentially the government would be able to negotiate a bulk deal with the company, and the cost would be spread between millions of people. Not to mention the costs of everything else involved would be lower due to the same principal.

Carjosse · Dec 16, 2017

ttwtt78640 said:
That (bolded above) is still not everyone which makes it necessary to establish priorities or revert to a lottery system. In either case, there will remain the option for those that have the financial means to jump the line.

Well in Canada's system would be the people closet to dying would be given the treatment first, not who can pay the the money first.

ttwtt78640 · Dec 16, 2017

Carjosse said:
Well in Canada's system would be the people closet to dying would be given the treatment first, not who can pay the the money first.

That seems to be completely at odds with the cancer survival rates which indicate that those detected and treated earliest have the best chance of recovery/survival.

https://www.theguardian.com/society/2015/aug/10/cancer-survival-rates-higher-early-diagnosis

Carjosse · Dec 16, 2017

ttwtt78640 said:
That seems to be completely at odds with the cancer survival rates which indicate that those detected and treated earliest have the best chance of recovery/survival.

https://www.theguardian.com/society/2015/aug/10/cancer-survival-rates-higher-early-diagnosis

I am not an expert on this, I have no idea how they determine it, I just know they do prioritize.

ttwtt78640 · Dec 16, 2017

Carjosse said:
I am not an expert on this, I have no idea how they determine it, I just know they do prioritize.

Exactly, as is the case with care providers giving priority to those that can (and do) pay. My point is that there are more people that need care than the ability to give that care. There are also folks that wait far too long to seek such care or have deteriorated to the point that the care itself would kill them. The bottom line is that everyone born will die - it is only a matter of when and from what.

https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm

mike2810 · Dec 16, 2017

Carjosse said:
Well in Canada's system would be the people closet to dying would be given the treatment first, not who can pay the the money first.

For me if I was on the last stages of living because of cancer, I would not accept nor take a treatment that may only add a few months/years to my life.
As others have said, the earlier the cancer is detected in its early stages of growth the better the chances of the person surviving and becoming cancer free.

As far as the Canadian system of health care:

https://www.fraserinstitute.org/sites/default/files/price-of-public-health-care-insurance-2016.pdf

" For the average Canadian family, between 2006 and 2016, the cost of public health care insurance increased 1.4 times faster than average income, 1.3 times as fast as the cost of food and at about the same pace as the cost of shelter"

" The 10% of Canadian families with the lowest incomes will pay an average of about $443 for public health care insurance in 2016. The 10% of Canadian families who earn an average income of $60,850 will pay an average of $5,516 for public health care insurance, and the families among the top 10% of income earners in Canada will pay $37,361.
"

jaeger19 · Dec 18, 2017

Carjosse said:
But waiting lists and people dying from not receiving the care they need never happens in the US. /s

Hmmmm

According to Morgan, Canada’s universal coverage is flawed because prescription drugs aren’t part of its public healthcare system.

“Every single country with universal coverage for healthcare provides universal coverage for prescription drugs. Except for Canada,” he says.

Since Judy didn’t qualify for government funding and no longer had private insurance she decided to stop taking her oral cancer drug because she didn’t want to bankrupt her family.

Judy died in hospital roughly six months later

https://globalnews.ca/news/1654757/canadian-patients-struggle-to-finance-cancer-treatment/

Before we start the finger pointing.. lets get the facts straight.
\
Canadian government insurance doesn't cover even the basic medications for cancer.

JuiceJS · Feb 13, 2018

Greenbeard said:
A couple months ago the FDA approved a new treatment for certain types of cancer. A little background on it:

CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers

Essentially you hand some of your white blood cells over to a drug company which engineers them to kill certain cancers, and then they're put back into you.

It's not the most pleasant of processes but it seems to have pretty impressive results.

The only snag is, somebody has to pay for it.

Months After Approval, Breakthrough Cancer Drug Given to Just Five Patients

The whole thing costs the hospital (or at least the few currently equipped and authorized to provide this service) a lot more than just the $373K sticker price to buy the cell engineering itself, there are potentially hundreds of thousands of additional dollars in costs for hospitals added on to that, not only in preparing for and administering the treatment once they send/get back from the drug company the cells but also in dealing with the toxicity to the patient of the process.

It's a (morbidly) interesting ethical dilemma. The people in line for this treatment are at the end of their rope, but no hospital can afford to give away a half million dollars or more of care per case without knowing if anyone is going to reimburse them for it.

I think the "ethical" dilemma has been answered time and time again by those with the know how and ability to use these techniques, basically reserved for the rich.

Glad to see the confusing of multiple different avenues for treatment though. Possibly having enough and with successful results may actually allow somewhat of a bidding war that may lower costs overall.

Outside of that, some of those charities that exist have millions of dollars, maybe they can put some to use and fix a few cancer patients.

Curing cancer ain't cheap!

Greenbeard

Carjosse

Sit Nomine Digna

Bum

I survived. Suck it, Schrodinger.

Superfly

Salty, defiant, and completely non-compliant.

Greenbeard

mike2810

Carjosse

Sit Nomine Digna

Carjosse

Sit Nomine Digna

ttwtt78640

Sometimes wrong

mike2810

ttwtt78640

Sometimes wrong

Carjosse

Sit Nomine Digna

Carjosse

Sit Nomine Digna

ttwtt78640

Sometimes wrong

Carjosse

Sit Nomine Digna

ttwtt78640

Sometimes wrong

mike2810

jaeger19

JuiceJS

Curing cancer ain't cheap!

Sit Nomine Digna

I survived. Suck it, Schrodinger.

Salty, defiant, and completely non-compliant.

Sit Nomine Digna

Sit Nomine Digna

Sometimes wrong

Sometimes wrong

Sit Nomine Digna

Sit Nomine Digna

Sometimes wrong

Sit Nomine Digna

Sometimes wrong

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