Economics of Cancer Medicines: For Whose Benefit?

Abstract

Although new cancer drugs are continually getting approved and used, the value that these drugs add is very debatable. Because of the skyrocketing cost of the new drugs, each new approval represents a multibillion market. However, unlike other branches of economics, cancer drugs are intricately associated with socio-political issues, emotional overlay, public pressure, industry manipulation and propaganda. In this article, we review the value added by new cancer drugs and examine the socio-political agenda around them with highlights on the increasing gulf between high-income and low-middle income countries regarding the affordability to these drugs. Finally, we also suggest a way forward to address this highly complex issue.

Enhancing global access to cancer medicines

“…During 2005 through 2017 (mean, 8‐year follow‐up) in the United States, the mean cumulative cost increase (adjusted for general inflation) for 24 injectable cancer drugs was 19.1% (95% CI, 11%‐27.2%) . In the United States, the largest payer for health care (Medicare) is not allowed to negotiate prices, and so cancer medicine prices are driven by pharmaceutical companies to what the market will bear . US cancer medicine prices may have a global impact if they are used to benchmark prices elsewhere in the world.…”

“…26 In the United States, the largest payer for health care (Medicare) is not allowed to negotiate prices, and so cancer medicine prices are driven by pharmaceutical companies to what the market will bear. 27 US cancer medicine prices may have a global impact if they are used to benchmark prices elsewhere in the world.…”

Association between progression‐free survival and patients’ quality of life in cancer clinical trials

“…Despite recent efforts to include quality of life data in clinical trials of cancer drugs, nearly half of the phase 3 RCTs did not include quality of life as an endpoint, and there was no improvement in the reporting of quality of life outcomes with time. Given the palliative intent of treatments in the advanced/metastatic setting and the rising costs of cancer care, the use of drugs that contribute to physical and financial toxicity, without providing tangible and meaningful benefits, raises ethical and practical challenges . Recent initiatives, such as the Setting International Standards in Analyzing Patient‐Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative, may improve the collection and reporting of quality of life information in the future.…”

“…Given the palliative intent of treatments in the advanced/metastatic setting and the rising costs of cancer care, the use of drugs that contribute to physical and financial toxicity, without providing tangible and meaningful benefits, raises ethical and practical challenges. [17][18][19][20][21] Recent initiatives, such as the Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative, 22 may improve the collection and reporting of quality of life information in the future. Medical journals could also help improve the availability of quality of life data by requiring the reporting of this information at the time of publication of primary efficacy results.…”

Negative phase 3 randomized controlled trials: Why cancer drugs fail the last barrier?

“…5 Because every cancer drug approval represents a potentially multibillion dollar market, current market provides incentives to undertake overpowered Phase 3 RCTs designed to detect marginal significances. 6,7 The Institutional Review Boards and approval authorities should take proactive steps to discourage Phase 3 RCTs that don't have positive data from previous Phase 2, especially those Phase 3 that are being planned despite negative Phase 2. Another important step would be to define when a Phase 2 would be considered positive a priori, because a significant proportion of Phase 2 trials in our study were inconclusive.…”