Abiraterone (Zytiga), Provenge — New Overpriced Approaches to Prostate Cancer

It’s remarkable how insensitive to price we are in medicine, particularly when the illness is severe and likely fatal. You may say well that’s appropriate as there is no price one can place on life. The big drug companies, however, sensing this “weakness” cannot resist taking advantage.

In the case of Provenge, proven to increase median survival 4 months, the charge is $93,000. In the case of abiraterone a hormonal blocker (blocks androgen biosynthesis more completely) the cost will be in the range of $5,000/month with a median survival benefit of about 4 months.

After a median follow-up of 12.8 months, overall survival was longer in the abiraterone acetate–prednisone group than in the placebo–prednisone group (14.8 months vs. 10.9 months; hazard ratio, 0.65; 95% confidence interval, 0.54 to 0.77; P<0.001). Data were unblinded at the interim analysis, since these results exceeded the preplanned criteria for study termination. All secondary end points, including time to PSA progression (10.2 vs. 6.6 months; P<0.001), progression-free survival (5.6 months vs. 3.6 months; P<0.001), and PSA response rate (29% vs. 6%, P<0.001), favored the treatment group. Mineralocorticoid-related adverse events, including fluid retention, hypertension, and hypokalemia, were more frequently reported in the abiraterone acetate–prednisone group than in the placebo–prednisone group.

Medicynical Note: It’s wonderful that there are options for prostate cancer patients that appear to have some benefit. It’s not wonderful that the cost of these innovations exceed the yearly income of most Americans. One wonders who would be able to pay for such advances if Medicare (insurer of most patients with prostate cancer) became a voucher system that didn’t fully cover the treatment, or failed outright.

Our non-system of health care is in crisis. The Obama administration has passed a plan that will moderate Medicare costs by using care more cost-effectively and cover most of our population. Patients would always have the option of paying themselves for whatever care they desired if not covered by Medicare.

The republican counter plan does nothing for the uninsured. It appears to provide vouchers for Medicare recipients without certainty that those with illness will be able to afford either the insurance or the associated deductibles and co-pays.

In the end, I guess we’ll get what we deserve.

Meanwhile the pharmaceutical industry overcharges those with the most severe illnesses to assure their continued excessive profits. As a result, costs of drugs continue to increase at several multiples of inflation, even during the “great recession.”

Addendum: June 9: Additional results of this study presented at the ASCO meeting claims better results than in the abstract:

Overall survival in the phase 3 trial was 15.8 months in the abiraterone group and 11.2 months in the placebo group (P < .0001); median follow-up was 20.2 months, said investigator Howard I. Scher, MD, from Memorial Sloan-Kettering Cancer Center in New York City, at a press conference.

Quite modest improvement given the price.

I’m remain amazed that medicine has come to drugs costing $5000/month with very limited benefit. No wonder the “systems” are failing–our national financial system, our health care non-system, and the world’s view of intellectual property rights. Overpricing in the long run leads no where, and that appears to be where we are going.

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