The cost of health care has risen considerably over the last 10 years, with increased costs to employer and employee alike1. Next to heart disease, cancer is the second most costly medical condition in the United States2, with the exorbitant costs of newly marketed drugs, or specialty drugs, being a hotly debated topic.
Prior to the year 2000, the average annual price for cancer care drugs in the United States was less than $10,000 per person, and has increased to a cost over $100,000 in 20123. During that same period, however, deaths attributed to cancer have only decreased slightly, by 1-2% 4, annually.
In the field of cancer drug development, a marked progression has been observed with increasingly specific or targeted drugs being brought to the market for cancer treatment and adjuvant therapy. Certainly, in recent years a number of successful biologics have been licensed for the targeted treatment of various malignancies5. These biologics largely comprise antibodies which: 1) block growth signals to growing tumors; 2) deliver chemotherapeutics; and/or, 3) induce immune activation. Due to the increased complexity in the manufacture of antibodies, they carry a higher price tag than their small-molecule predecessors. Whereas, small-molecules can be chemically synthesized, antibodies are produced in cells, they must require more careful handling6.
Above and beyond the application of biologics in cancer treatment, and intensely pursued new avenue of research is cell therapy. This exciting and powerful new type of therapy is currently the most personalized variety of medicine, and also the most costly. Cell therapy involves the collection of immune cells from patients, conditioning or genetically engineering these cells, and the subsequent reinfusion of the cells back into the patient. It is not difficult to imagine why this type of procedure is enormously expensive. The cost of a single cell therapy treatment is estimated to reach $500,000, and require a reimbursement structure for coverage dependent upon the success of the treatment7.
In 2010, Dendreon Corp. received FDA approval for the first cancer vaccine, Provenge TM, which treats prostate cancer. Notwithstanding the high incidence of prostate cancer, market uptake of Provenge TM has been underwhelming due to its high $93,000 price tag.
As the incidence of cancer continues its incline, there will continue to be a financial burden placed upon the health care system. The cost-to-benefit ratio of these emerging therapies is now becoming more and more apparent as prices continue to rise. Certainly, as the new wave of biologics and cell therapies reach the market, their costs will necessitate innovative new strategies to fund such treatment.
1. Claxton, G. et al. 2014 Employer Health Benefits Survey. kff.org (2014). at
2. Chastek, B. et al. Health Care Costs for Patients With Cancer at the End of Life. jop.ascopubs.org
3. Kantarjian, H. & Rajkumar, S. V. Why Are Cancer Drugs So Expensive in the United States, and What Are the Solutions? Mayo Clinic Proceedings 90, 500–504 (2015).
4. Kohler, B. A. et al. Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J. Natl. Cancer Inst. 107, (2015).
5. Scott, A. M., Wolchok, J. D. & Old, L. J. Antibody therapy of cancer. Nat. Rev. Cancer 12, 278–287 (2012).
6. Ryan, A. M. Frontiers in Nonclinical Drug Development: Biosimilars. Veterinary Pathology 52, 419–426 (2015).
7. Ledford, H. T-cell therapy extends cancer survival to years. Nature 516, 156 (2014).
Article written by J.D. Burke
Posted June 24, 2015