Steady Increase In Prices For Oral Anticancer Drugs After Market Launch Suggests A Lack Of Competitive Pressure

Bennette, Caroline S.; Richards, Catherine; Sullivan, Sean D.; Ramsey, Scott D.

doi:10.1377/hlthaff.2015.1145

Cited by 69 publications

(52 citation statements)

References 23 publications

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“…Essentially, pharmaceutical companies could name their price and tag on year-after-year price increases. 50,67 As long as it was not an egregious increase as occurred with Daraprim (Turing Pharmaceuticals) or EpiPen (Mylan), no one noticed. 68,69 This needs to change.…”

Section: Negotiation Of Prices and Formulary Controlmentioning

confidence: 99%

Next-generation multiple myeloma treatment: a pharmacoeconomic perspective

Rajkumar

Harousseau

2016

Blood

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Advances in the diagnosis and treatment of multiple myeloma have come at a rapid pace, especially with several new drugs entering the market in the last few years. However, access to and affordability of new treatments poses a major challenge, both in the United States and around the world. High costs of life-saving drugs are detrimental to both the personal finances of the individual patient, as well as society which must bear the increasing costs in terms of increased health insurance premiums, taxes, or both. The challenges are not unique to myeloma, but are commonly encountered in several other cancers as well. But to some extent these pharmacoeconomic concerns are amplified in myeloma due to the need for multidrug regimens that combine 2 or more expensive new drugs, continuous therapy, and the prolonged disease course in most patients. We examine current myeloma therapy from a pharmacoeconomic perspective, and discuss the costs involved. We outline the underlying reasons why cancer drugs are so expensive, the measures that are required to lower cost, and propose potential ways in which costs can be reduced while still delivering high-quality care.

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Section: Negotiation Of Prices and Formulary Controlmentioning

confidence: 99%

Next-generation multiple myeloma treatment: a pharmacoeconomic perspective

Rajkumar

Harousseau

2016

Blood

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“…Financial barriers may lead to poor adherence to medications, resulting in worse health outcomes, including earlier mortality . Over the past decade, novel anti‐cancer drugs have had increasing costs associated with higher launch prices and subsequent post‐launch price elevations without a proportional increase in their clinical benefits . These prohibitive costs have prompted the need to critically evaluate the value of anti‐cancer drugs.…”

Section: Introductionmentioning

confidence: 99%

“…7 Over the past decade, novel anti-cancer drugs have had increasing costs associated with higher launch prices and subsequent postlaunch price elevations without a proportional increase in their clinical benefits. [8][9][10][11][12][13][14][15] These prohibitive costs have prompted the need to critically evaluate the value of anti-cancer drugs. Several organizations, including the American Society of Clinical Oncology 16 and the European Society for Medical Oncology, 17 have developed frameworks to appraise the value of anti-cancer agents, which includes and assessment of the clinical benefits, toxicities, and costs of these medications.…”

Section: Introductionmentioning

confidence: 99%

The impact of pricing strategy on the costs of oral anti‐cancer drugs

et al. 2019

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Background The soaring costs of anti‐cancer drugs pose a threat to the sustainability of cancer care. The pricing strategy chosen by manufacturers can impact the costs of oral anti‐cancer drugs during dose modifications, but this issue remains under‐recognized in the literature. In general, with the flat pricing strategy, there is a single fixed price for each tablet regardless of dosage strength, whereas with linear pricing, the price of each tablet increases with its dose. We hypothesize that flat pricing will have increased drug costs compared to linear pricing during dose reductions since the cost remains fixed despite decreased dose requirements. This practice may have significant financial implications considering the high costs, extensive utilization, and frequent occurence of dose reductions with anti‐cancer drugs. Methods Oral anti‐cancer drugs reviewed by the pan‐Canadian Oncology Drug Review program between 2011 and 2018 were identified. The cost per mg and cost per 28‐day cycle were calculated for dose levels −2 to +2. The percent change in cost per mg and cost per cycle during dose modifications from the standard dose were calculated. We conducted Mann‐Whitney U and Fisher‐exact tests to compare the association between drug costs during dose reductions and pricing strategy. Results In this study, 30 oral anti‐cancer drugs for use in 41 indications were analyzed; 44% of drugs used linear pricing and 56% used flat pricing. Dose reductions increased the mean cost per mg for drugs with linear pricing by 14.7% (range: 0%‐50%) at dose level −1 and 17.2% (range: 0%‐50%) at dose level −2 and flat pricing by 60.8% (range: 19%‐100%) at dose level −1 and 99.1% (range: 0%‐300%) at dose level −2. The cost per mg was significantly increased in drugs using flat pricing compared to linear pricing when dose reduction to either level ‐1 ( P = 0.010) or level ‐2 ( P = 0.006) occurred. The mean cost per cycle was decreased for drugs using linear pricing by 20.9% (range: −40% to 0%) at dose level −1 and 48.7% (range: −60% to −25%) at dose level −2 and flat pricing by 0.8% (range −6% to 0%) at dose level −1 and 11.0% (range: −50% to 100%) at dose level −2. The cost per cycle was significantly decreased in drugs with linear pricing compared to flat pricing when the standard dose is reduced to either dose level ‐1 ( P = 0.005) or dose level ‐2 ( P = 0.026). Conclusions Overall, flat pricing had significantly greater costs compared to linear pricing during dose reductions of anti‐cancer drugs. While there is a general expectation that the cost of drugs should decrease with dose reduction, drugs with flat pricing were generally found to have increased cost per mg and no change in the cost per cycle. The resultant increased spending on drug acquisition (despite purchasing...

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“…A lead researcher pressed Gleevec's manufacturer, Novartis, to produce more Gleevec; yet Novartis declined to do so, claiming that Gleevec was not a high priority for the company, given the relatively small number of people affected with CML and potential risks of a new experimental therapy 26. After Gleevec received FDA approval in 2001 to treat certain adults with CML, it was subsequently approved for 10 additional indications, which led to increases in demand as well as increases in the price of the drug 27. As with ZMapp and AZT, the line between research and healthcare blurs, as do the justice claims at stake.…”

Section: Introductionmentioning

confidence: 99%

From protection to entitlement: selecting research subjects for early phase clinical trials involving breakthrough therapies

et al. 2017

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Our goals are to (1) set forth and defend a multiprinciple system for selecting individuals who meet trial eligibility criteria to participate in early phase clinical trials testing chimeric antigen receptor (CAR T-cell) for acute lymphoblastic leukaemia when demand for participation exceeds spaces available in a trial; (2) show the relevance of these selection criteria to other breakthrough experimental therapies; (3) argue that distinct distributive justice criteria apply to breakthrough experimental therapies, standard research and healthcare and (4) argue that as evidence of benefit increases, the emphasis of justice in research shifts from protecting subjects from harm to ensuring fair access to benefits.

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Steady Increase In Prices For Oral Anticancer Drugs After Market Launch Suggests A Lack Of Competitive Pressure

Cited by 69 publications

References 23 publications

Next-generation multiple myeloma treatment: a pharmacoeconomic perspective

Next-generation multiple myeloma treatment: a pharmacoeconomic perspective

The impact of pricing strategy on the costs of oral anti‐cancer drugs

From protection to entitlement: selecting research subjects for early phase clinical trials involving breakthrough therapies

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