US sees more expensive cancer drugs at launch, and things get worse from there


Introductory cancer drug prices over the past decade were considerably higher in the United States than in similar high-income European countries, and the gap only widened in the years following approval, according to one. economic analysis.

From 2009 to 2019, median monthly treatment costs for new drugs at launch reached $ 11,755 in the United States, compared to $ 8,305 in Germany, $ 6,955 in Switzerland and $ 7,355 in England, reported Kerstin N. Vokinger, MD, JD, PhD, University of Zurich and colleagues.

And, as described in JAMA Oncology, prices were not necessarily associated with clinical benefits in any of the countries studied.

“The results of this study suggest that while the United States should take the most important steps to deal with the high costs of cancer drugs, Europe may also review its tariff regulations to ensure better alignment with value. clinic, ”the group wrote.

“The two main lessons from this study are that drug prices are rising faster in the United States than in Europe, and that regardless of geography, drug prices do not reflect clinical benefits,” Syed Yousuf Zafar, MD, of the Margolis Center for Health Policy at Duke University in Durham, North Carolina, said MedPage today.

“This second point should not be lost,” said Zafar, who was not involved in the study. “In light of the recent uproar around the Alzheimer’s disease drug, aducanumab [Aduhelm], we must not forget that cancer drugs are approved at 10 times the price, but with only incremental additional benefits. “

Vokinger’s team identified 65 new drugs approved by the FDA between January 1, 2009 and December 31, 2019, with initial indications for adult solid tumors and hematologic cancers. They included for analysis anticancer drugs approved by the European Medicines Agency (EMA) and Swissmedic before December 31, 2019 for the same indications as in the United States.

The researchers extracted the introductory prices and annual price changes of these drugs in the United States, England, Germany and Switzerland. To assess the clinical benefit of these anticancer drugs, they applied two valuable frameworks at product launch and at the end of the study period, to the pivotal clinical trials supporting regulatory approval:

  • European Society for Medical Oncology Scale for the Magnitude of Clinical Benefits (ESMO-MCBS) v1.1
  • American Society of Clinical Oncology (ASCO) Values ​​Framework v2.0 (ASCO-VF)

The lowest monthly treatment costs at launch were higher in the three European countries at the end compared to the start of the study period (2018-2019 vs 2009-2010, respectively), and significantly in the United States:

  • Germany: $ 5,888 vs. $ 4,289
  • Switzerland: $ 6,593 vs. $ 5,784
  • England: $ 6,867 vs. $ 3,939
  • United States: $ 14,580 versus $ 5,790

During the study, 74% of cancer drugs experienced unit price increases in the United States that were greater than inflation. On the other hand, none of the 60 drugs in Germany, only one of the 62 in England and only seven of the 56 drugs in Switzerland experienced median unit price increases above inflation.

In total, the median change in the unadjusted unit price after launch in the United States was 4.9% per year and 2.7% per year after adjusting for inflation. However, England, Germany and Switzerland all saw their prices drop after adjusting for inflation.

“There was no association between introductory prices and clinical benefit using ASCO-VF or ESMO-MCBS scores or between post-launch price changes and clinical benefit,” reported Vokinger and colleagues.

Vokinger’s group suggested that if policymakers want to tackle the high cost of cancer drugs, they need to consider both introductory prices and the cumulative effect of price changes after approval.

“An important step would be to allow CMS to negotiate the prices of the drugs,” Zafar said. “Our inability to negotiate drug prices at the federal level makes a significant difference between health policy in the United States and in Europe. Price negotiation is not a panacea, but it must serve as a critical first step.”

The Elijah E. Cummings Lower Drug Costs Now Act (HR 3), which the House of Representatives is currently grappling with, contains a number of far-reaching drug price reforms, including a provision giving the secretary of the HHS has the power to negotiate certain prescription drug prices. for health insurance and the private market.

Meanwhile, Zafar stressed that while oncologists have no control over the price of drugs, “we have control over how drugs are prescribed.”

“We have to treat patients on the basis of the best evidence,” he said. “When more than one drug of equal efficacy exists in a particular class, we should prescribe the cheapest drug. Using evidence-based clinical pathways has been shown to reduce costs while maintaining l ‘efficiency.”

  • Mike Bassett is a writer specializing in oncology and hematology. He is based in Massachusetts.

Disclosures

The study was supported by the Swiss National Science Foundation and the Swiss Foundation for Cancer Research.

Vokinger has not disclosed any relationship with the industry. The co-authors disclosed connections and / or support from Arnold Ventures, Roche, Ipsen, Pfizer, and Eli Lilly.

Zafar revealed their relationships with Shattuck Labs, AIM Specialty Health, McKesson, RTI Health Solutions, Discern Health, WIRB-Copernicus Group and AstraZeneca.


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