Another Marginal $100,000 treatment–Provenge

Provenge, why so expensive? Yes there are development costs and clincal trials to pay for but not enough, in my view, to justify the pricing. We talk about holding practitioner’s fees down by looking at outcomes, shouldn’t we do the same with drugs that cost 100 times more?

The FDA by the way is not allowed to assess cost efficacy, their mandate is to document lack of harm and have evidence of minimal benefit. Interestingly, many times in the past the initial studies benefit was proven to be overstated and the risks understated.

The treatment’s benefits are modest. But as the first product of its type to emerge from decades of often-frustrating research, Provenge could help open doors for immune-based therapies against a range of cancer.

Analysts estimate a course of Provenge will cost between $50,000 and $75,000. As many as 100,000 men a year develop the advanced form of prostate cancer the treatment would initially be prescribed for. At that rate, Dendreon could rack up well over $1 billion in annual sales in a few years, said David Miller, president of Biotech Stock Research in Seattle. If the company isn’t swallowed up by a pharmaceutical firm — a big “if” — its success would boost the region’s stature and draw as a biotech hub.

The vaccine boosted median survival time by 4 months, from 22 months in the placebo group to 26 months in the Provenge group.

Medicynical note: The company claims an investment of $750,000,000–it’s been thought by many that these “investments” are routinely overstated (Read Marcia Angell and her book The Truth About the Drug Companies: How they Deceive Us and What to Do about it). Dendreon’s estimate is that the drug in the first year will provide over a billion dollars in sales. Don’t expect the prices to go down with time.

It is the American way to reward innovation and this approach clearly is innovative, though modestly effective. But can any system afford such pricing for an incremental (3-4 month), if that, improvement? Isn’t there a more efficient way to drug development? If health insurance wasn’t there to buffer patients and their families could the majority of us afford such an “advance.” Can we as a failing society, slowly bankrupting ourselves, afford it?

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