• This is a political forum that is non-biased/non-partisan and treats every person's position on topics equally. This debate forum is not aligned to any political party. In today's politics, many ideas are split between and even within all the political parties. Often we find ourselves agreeing on one platform but some topics break our mold. We are here to discuss them in a civil political debate. If this is your first visit to our political forums, be sure to check out the RULES. Registering for debate politics is necessary before posting. Register today to participate - it's free!

Will price be a barrier to new cancer immunotherapy?

TU Curmudgeon

B.A. (Sarc), LLb. (Lex Sarcasus), PhD (Sarc.)
DP Veteran
Joined
Mar 7, 2018
Messages
51,409
Reaction score
13,890
Location
Lower Mainland of BC
Gender
Male
Political Leaning
Centrist
From the CBC

Will price be a barrier to new cancer immunotherapy?

A revolutionary new cancer treatment is now available in Canada, but provinces are being advised not to cover it until the price comes down — a price that is being kept secret from Canadians.

Health Canada approved Kymriah (tisagenlecleucel) in September. It's a form of CAR-T immunotherapy, in which a patient's blood cells are removed, reprogrammed to attack cancer and then re-injected back into their body.

For the first time ever, some Canadians with specific forms of hard-to-treat leukemia and lymphoma can be treated with this therapy. If their doctors decide they're candidates, they won't have to wait to be accepted into a clinical trial.

But that approval created a Rubik's Cube of decision-making problems: How to pay for a treatment so expensive that something else in the health care budget will have to be dropped, a treatment so new that there is no long-term survival data, a treatment so complex that some regions don't have the facilities to offer it?

COMMENT:-

The treatment appears to cost between $300,000 and $500,000 per patient and there appears to be fewer than 3 patients per 100,000 who would benefit from it.

Admittedly this question would never arise in the United States of America because anyone who could raise the (let's call it) $400,000 required to pay for the treatment (plus the additional hospital and medical personnel costs) would be able to receive it. (Of course, any Canadian who could raise the "$400,000" [plus the additional hospital and medical personnel costs] to pay for the treatment could be able to receive it too simply going to the United States of America.) Whether or not VA, Medicare, and/or private insurance companies will pay for this treatment in the US will be decided by "coverage and benefit analysts" (who are NOT to be confused with "Death Panels").

PS - With approximately 10,000 potential patients - right now - in the US, the treatment would return around $4,000,000,000 if all those patients were treated. That $4,000,000,000 should defray the R&D costs "slightly" and then there would only be the number of new cases that arose annually that would have to be treated.

PPS - The treatment does not appear to actually "cure" anything, only to provide a 50% to 80% chance of living for another year so that makes me wonder if the treatment would actually have to be administered annually.​
 

DaveFagan

Iconoclast
DP Veteran
Joined
Mar 20, 2011
Messages
10,090
Reaction score
5,056
Location
wny
Gender
Undisclosed
Political Leaning
Conservative
It does not sound "cost effective." Would the money be better spent to hit a larger percentage of patients? I'm not trying to make a case for ROI, but total humanitarian impact.
/
 

Greenbeard

DP Veteran
Joined
Aug 10, 2013
Messages
17,870
Reaction score
17,521
Location
Cambridge, MA
Gender
Male
Political Leaning
Slightly Liberal
PPS - The treatment does not appear to actually "cure" anything, only to provide a 50% to 80% chance of living for another year so that makes me wonder if the treatment would actually have to be administered annually.

They take the patient's T-cells and re-engineer them to attack that particular form of cancer. Those are the patient's cells, they remain in his body, able to attack those cancers. That's why people call this a "living drug." It's not really a drug at all.
 

TU Curmudgeon

B.A. (Sarc), LLb. (Lex Sarcasus), PhD (Sarc.)
DP Veteran
Joined
Mar 7, 2018
Messages
51,409
Reaction score
13,890
Location
Lower Mainland of BC
Gender
Male
Political Leaning
Centrist
It does not sound "cost effective." Would the money be better spent to hit a larger percentage of patients? I'm not trying to make a case for ROI, but total humanitarian impact.

Part of the problem is that the existing medications actually do a pretty good (which is not the same thing as "perfect") job of dealing with all of the major diseases that are susceptible to "mass treatment".

That means that the drug companies have to either spend money trying to find ways around the existing patents or concentrate on conditions where the odds on recovering the cost of R&D are directly related to how high the drug companies can push their prices.

In the first scenario, the drug companies are (essentially) reinventing the wheel, and in the second they are (pretty much) throwing money down rat holes in the hopes of scaring out a rabbit.

If "Drug A" works on 90% of the cases (all percentages for illustrative purposes only) and "Drug B" drug is developed that [a] will cost more that "Drug A" and also works on 90% of the 10% that "Drug A" didn't work on, its "market" is actually only with the 10% that "Drug A" didn't work on - and that is only 9% of the population at risk.


Now if "Drug C" is developed that [a] will cost more that "Drug B" and also works on 90% of the 10% that "Drug B" didn't work on, its "market" is actually only with the 10% that "Drug B" didn't work on- and that is only 0.9% of the population at risk.


And if "Drug D" is developed that [a] will cost more that "Drug C" and also works on 90% of the 10% that "Drug C" didn't work on, its "market" is actually only with the 10% that "Drug C" didn't work on- and that is only 0.09% of the population at risk.



As you can see the point of vanishing returns can get reached pretty quickly.

However, the drug companies pretty much have to keep on spending money of R&D because it is their R&D spending that they use to justify the prices that they charge.
 

TU Curmudgeon

B.A. (Sarc), LLb. (Lex Sarcasus), PhD (Sarc.)
DP Veteran
Joined
Mar 7, 2018
Messages
51,409
Reaction score
13,890
Location
Lower Mainland of BC
Gender
Male
Political Leaning
Centrist
They take the patient's T-cells and re-engineer them to attack that particular form of cancer. Those are the patient's cells, they remain in his body, able to attack those cancers. That's why people call this a "living drug." It's not really a drug at all.

Thanks for the explanation.

So what the drug companies have (essentially) done is to create a way of "engineering" a sort of "one off" solution that has to be custom built for each patient.

Although the analogy is crude, isn't that sort of like putting a cast on each individual broken leg rather than turning off the rotating flails that are breaking the legs?

(Admittedly there is more profit to be made in selling the casts than there is in turning off the rotating flails.)
 

Greenbeard

DP Veteran
Joined
Aug 10, 2013
Messages
17,870
Reaction score
17,521
Location
Cambridge, MA
Gender
Male
Political Leaning
Slightly Liberal
Thanks for the explanation.

So what the drug companies have (essentially) done is to create a way of "engineering" a sort of "one off" solution that has to be custom built for each patient.

Although the analogy is crude, isn't that sort of like putting a cast on each individual broken leg rather than turning off the rotating flails that are breaking the legs?

(Admittedly there is more profit to be made in selling the casts than there is in turning off the rotating flails.)

The only people getting this treatment at this point are those who have unsuccessfully tried multiple other courses of treatment for these cancers. They're invariably very sick and this therapy is their last chance. It's costly not just because buying the actual product from the drug companies is hundreds of thousands of dollars, but also because the hospitals (the relatively small number of treatment centers around the country with the capability and authorization to do so) administering the re-engineered cells incur substantial costs, often even greater than the cost of re-engineering the cells, in treating the toxicities associated with the therapy.

But those facilities have been providing it and from what I've seen insurers--even before they covered the treatment--have been paying for it because it's the only thing left that can possibly save those lives. It's a remarkable treatment.
 

DaveFagan

Iconoclast
DP Veteran
Joined
Mar 20, 2011
Messages
10,090
Reaction score
5,056
Location
wny
Gender
Undisclosed
Political Leaning
Conservative
Part of the problem is that the existing medications actually do a pretty good (which is not the same thing as "perfect") job of dealing with all of the major diseases that are susceptible to "mass treatment".

That means that the drug companies have to either spend money trying to find ways around the existing patents or concentrate on conditions where the odds on recovering the cost of R&D are directly related to how high the drug companies can push their prices.

In the first scenario, the drug companies are (essentially) reinventing the wheel, and in the second they are (pretty much) throwing money down rat holes in the hopes of scaring out a rabbit.

If "Drug A" works on 90% of the cases (all percentages for illustrative purposes only) and "Drug B" drug is developed that [a] will cost more that "Drug A" and also works on 90% of the 10% that "Drug A" didn't work on, its "market" is actually only with the 10% that "Drug A" didn't work on - and that is only 9% of the population at risk.


Now if "Drug C" is developed that [a] will cost more that "Drug B" and also works on 90% of the 10% that "Drug B" didn't work on, its "market" is actually only with the 10% that "Drug B" didn't work on- and that is only 0.9% of the population at risk.


And if "Drug D" is developed that [a] will cost more that "Drug C" and also works on 90% of the 10% that "Drug C" didn't work on, its "market" is actually only with the 10% that "Drug C" didn't work on- and that is only 0.09% of the population at risk.



As you can see the point of vanishing returns can get reached pretty quickly.

However, the drug companies pretty much have to keep on spending money of R&D because it is their R&D spending that they use to justify the prices that they charge.


Nice post. I do, however, not think you have given enough weitght/acknowledgement to "GREED" in the DORPORATE USA system.
/
 

Taylor

DP Veteran
Joined
Aug 31, 2009
Messages
24,037
Reaction score
10,828
Location
US
Political Leaning
Undisclosed
But that approval created a Rubik's Cube of decision-making problems: How to pay for a treatment so expensive that something else in the health care budget will have to be dropped,
So they have a panel of sorts tasked with determining how best to ration healthcare. Interesting.
 

TU Curmudgeon

B.A. (Sarc), LLb. (Lex Sarcasus), PhD (Sarc.)
DP Veteran
Joined
Mar 7, 2018
Messages
51,409
Reaction score
13,890
Location
Lower Mainland of BC
Gender
Male
Political Leaning
Centrist
So they have a panel of sorts tasked with determining how best to ration healthcare. Interesting.

They have a panel that assesses cost/benefits. That panel is independent from the panel that determines coverage.

Insurance companies have "panels" that assess cost/benefits. Those panels are NOT independent from the "panels" that determine coverage.

The difference is that, in the first instance, the panel that determines coverage is NOT acting in breach of its fiduciary duty if it recommends that a treatment with a negative cost/benefit ratio be approved "because it's the right thing to do" whereas in the second instance the panel that determines coverage can get its ass sued off if it did (unless they could show that the PR value (read as "increased overall corporate profits") actually outweighed the loss of profits on the treatment).
 

Helix

Administrator
Moderator
DP Veteran
Joined
Jul 1, 2011
Messages
83,164
Reaction score
73,026
Gender
Male
Political Leaning
Independent
Will price be a barrier to new cancer immunotherapy?

initially, yes. however, eventually, hopefully not. a lot of scientists are working on this every day.
 

Taylor

DP Veteran
Joined
Aug 31, 2009
Messages
24,037
Reaction score
10,828
Location
US
Political Leaning
Undisclosed
They have a panel that assesses cost/benefits. That panel is independent from the panel that determines coverage.
So you're saying they have a panel that assesses cost/benefits in addition to the one that rations healthcare?
 

Greenbeard

DP Veteran
Joined
Aug 10, 2013
Messages
17,870
Reaction score
17,521
Location
Cambridge, MA
Gender
Male
Political Leaning
Slightly Liberal
CAR T is a good reminder that even expensive treatments can be cost effective.

CAR T-cell therapy cost-effective compared with past treatments
SAN DIEGO — Chimeric antigen receptor T-cell therapy has improved health outcomes at a more cost-effective rate than other cancer treatments, according to a study presented at ASH Annual Meeting and Exposition.

Data suggest that price increases of pharmaceutical oncology treatments have outpaced survival improvements. However, these study findings reveal that chimeric antigen receptor (CAR) T-cell therapy represents a break with the past trends of low-value innovation, according to the researchers.

“I think CAR T therapy clearly was significantly better in terms of incremental qualities when compared with both other treatments for hematologic cancers and treatments for nonhematologic cancers,” James Baumgardner, PhD, senior research economist at Precision Health Economics, said during his presentation. “In terms of trends, the introduction of CAR T therapy represents a major break of the trend of declining incremental effectiveness while showing similar cost-effectiveness to other innovations.”

Researchers identified all analyses of pharmaceutical treatments for cancer published since 2007 in the Tufts Medical Center Cost-Effectiveness Analysis Registry, which quantifies health benefits in terms of quality-adjusted life-years (QALYs). Researchers derived cost-utility analysis data for CAR T-cell therapies from a study conducted in 2018 by the Institute for Clinical and Economic Review.

The analysis compared interventions for nonhematologic cancers with non-CAR T interventions for hematologic cancers, which were compared with CAR T-cell therapy.
 

Deuce

Outer space potato man
DP Veteran
Joined
Feb 6, 2010
Messages
94,107
Reaction score
46,574
Gender
Male
Political Leaning
Undisclosed
So you're saying they have a panel that assesses cost/benefits in addition to the one that rations healthcare?

All healthcare is rationed.
 

Checkerboard Strangler

Meat with eyes!
Supporting Member
DP Veteran
Joined
Aug 8, 2005
Messages
60,383
Reaction score
42,168
Location
Los Angeles
Gender
Male
Political Leaning
Undisclosed
All healthcare is rationed.

All healthcare has always been rationed.
My son's healthcare right now, the only healthcare that will keep him alive long term, is a new heart.

But if he cannot maintain rigorous discipline with his weight and other health indicators for a long enough period of time, they cannot put him on the transplant list. If he cannot shed enough water weight, he will not qualify, not for all the money in the world.

So in the end it doesn't really matter if a panel of experts rations your care, or if your own body forces the decision anyway.
Ability to benefit isn't a cruel decision by an uncaring panel, it's a recognition that you may be too sick to get anything out of the treatment.
 

TU Curmudgeon

B.A. (Sarc), LLb. (Lex Sarcasus), PhD (Sarc.)
DP Veteran
Joined
Mar 7, 2018
Messages
51,409
Reaction score
13,890
Location
Lower Mainland of BC
Gender
Male
Political Leaning
Centrist
So you're saying they have a panel that assesses cost/benefits in addition to the one that rations healthcare?

Aside from the fact that healthcare is no more "rationed" in Canada than it is in the US, yes.

In Canada the "rationing body" is the body that pays for the facilities based on what it perceives as community need. In the US the "rationing body" is the body (actually many bodies, but who's counting) that pays for the facilities based on what it perceives as profit opportunity.

In both countries "cost/benefit analysis" is performed by accountants and actuaries.

I am 74 years old and my healthcare is "rationed" such that I

  • may not use facilities that do not exist,
  • may not get treatment for any medical condition that doesn't exist,
  • may not get treatment for any condition that I contracted before conception,
  • may not exceed the number of treatments/procedures that my medical condition requires, and
  • may not purchase medications that have not been approved for use in Canada. I'm further rationed in that I may not pay more than $10,000 (assuming that my income is $300,000 or more) for medications that are on the "approved" list (which includes almost all generic medications

My monthly direct premium for that, admittedly abysmal level (by US standards) of, medical coverage is $0.00 per month.

The extent of your medical coverage is, I am sure, much wider and costs less.

I may, however, pay more if I want to ensure that I'm only getting "Medication A" from a specific manufacturer and "Medication A" from that specific manufacturer is not on the "approved"list.
 

Taylor

DP Veteran
Joined
Aug 31, 2009
Messages
24,037
Reaction score
10,828
Location
US
Political Leaning
Undisclosed
Aside from the fact that healthcare is no more "rationed" in Canada than it is in the US, yes.
That's not true at all. In the U.S., most private insurance covers this treatment. With Medicare/Medicaid, you're lucky if it gets covered. In Canada, your life isn't worth the cost.
 

TU Curmudgeon

B.A. (Sarc), LLb. (Lex Sarcasus), PhD (Sarc.)
DP Veteran
Joined
Mar 7, 2018
Messages
51,409
Reaction score
13,890
Location
Lower Mainland of BC
Gender
Male
Political Leaning
Centrist
That's not true at all. In the U.S., most private insurance covers this treatment. With Medicare/Medicaid, you're lucky if it gets covered. In Canada, your life isn't worth the cost.

Please try reading for content.

Did you know that "Number of uninsured U.S. adults hits four-year high"?

Approximately 13.7% of U.S. adults had no medical insurance (2018 Q4 data). The equivalent percentage in Canada is (pick one):

  1. ____ 137.0%
  2. ____ 13.70%
  3. ____ 1.370%
  4. ____ 0.137%
  5. ____ less than 0.137%

BTW, when you say "most private insurance covers this treatment", don't you realize that that means that some don't and that the decision NOT to provide the treatment means that the treatment is "rationed"?

PS - Did you know that there is a difference between a "system" and "a single item"?

PPS - Since there are approximately 900 patients who would benefit from this treatment, and since not providing it means (as it appears you think it does) that the __[fill in the blank]__ doesn't think "your life is worth the cost", what would you say about a system where around 36,990,000 people have NO coverage at all?
 
Top Bottom