A tree falling in the woods–an abstract from ASCO

ASCO’s (the American Society for Clinical Oncology) yearly meeting was in early June. As usual there were many press releases. In the next few days I’ll highlight a few studies that were not noted in the news.

When one treats a patient with expensive interventions and there is improved survival it’s prudent to calculate the costs of the life extension. The best measure of a response to treatment is the QALY (quality adjusted life year). It is described here and here. Over the past several years expenditure of $50,000 in costs to improve survival a year has been considered acceptable for a therapeutic intervention. The question in our debt ridden system is whether we can we afford more for treatment interventions. The following implies that if the drug companies have their way we’ll be paying way more.

This abstract (#3515) is from the 2006 ASCO meeting. Direct cost-survival analysis of therapies for metastatic colorectal cancer reports the cost of increasing survival of patients with colorectal cancer (CRC) using various strategies. The chart from the abstract shows various treatment choices, their cost to the payer and the estimated improvement in survival.

It should be further noted that none of the interventions has been reported to cure metastatic CRC. Note that using the least effective treatment 5FU/LV patients survive a little over a year and with the most aggressive therapies just over two years. Note the cost for this improvement is over $150,000 for that additional year.

My conclusion is that we have some wonderful new biotech and chemotherapeutic approaches but unfortunately, as priced by the drug industry, they are not affordable. Such treatments are a little like trees falling in the woods.

Total Cost, Life Expectancy and CE Ratio compared to 5FU/LV and FOLFOX

Strategy Total
cost in
in weeks
CE Ratio/
to 5FU
CE Ratio/
5FU/LV 4,000 54.7 Base Case  
FOLFOX 44,000 70 2,600 Base Case
FOLFIRI then FOLFOX 55,000 84.4 1,700 800
FOLFOX /Bevacizumab then Irinotecan 114,000 95.1 2,700 2,800
FOLFOX then Irinotecan then Irinotecan/Cetuximab 118,000 104.7 2,300 2,100
FOLFIRI/Bev then FOLFOX then Cetuximab 132,000 113.8 2,200 2,000
FOLFOX/Bevacizumab then Irinotecan then Cetuximab 138,000 111.9 2,300 2,240
FOLFIRI/Bevacizumab then FOLFOX then Cetuximab/Irinotecan 165,000 118.3 2,500 2,500
FOLFOX/Bevacizumab then Irinotecan then Cetuximab/Irinotecan 173,000 116.7 2,700 2,800
Based on a 70 year old, 70 kg male with a BSA 1.7m

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