During the periodic American Cancer Society money drives, or at the time of the American Society of Clinical Oncology meetings we are told by fund raisers for cancer charities, drug companies and indeed some institutions out recruiting patients of the great progress being made in cancer treatment. What is not clearly revealed is that the great progress in decreased mortality from cancer has not been so much in treatment but rather in prevention (smoking cessation, abandonment of estrogen replacement, etc) and earlier diagnosis mostly from better disease screening.
To me, having practiced from the 70s until 2001, the major revolution in cancer treatment was not cures but costs. We’ve been talking for several years about the spiraling increase in drug costs and limited benefit of many new drugs—i.e. the disparity between the drug company’s hype and actual outcomes. Stephen Hall in New York Magazine covers much the same territory in his October 20th article, The Cost of Living. In the article Hall notes:
Several weeks earlier, Saltz had traveled to Chicago to inflict a little premonitory sticker shock on his medical colleagues. He reviewed the recent clinical results of both Zaltrap and Avastin when used as a “second line” treatment, after initial treatment had failed. As Saltz reminded the other oncologists, Avastin was modestly effective as a second-line treatment—it extended median overall survival by 42 days, the same as Zaltrap—but it cost about $5,000 a month and, like Zaltrap, would have to be taken for many months to achieve that modest clinical benefit. The overall cost was so high that Saltz devoted the end of his talk to a back-of-the-envelope calculation, delivered via PowerPoint, that recast the question in terms of health-care costs: If you extended the 42 days survival to a year, “what is the cost of Avastin for one year of human life saved?”
The answer was astounding, even to doctors who have grown inured to the zero-gravity economics of cancer pharmaceuticals. As Saltz worked his way through slide 73 of 78, he arrived at the bottom line: $303,000.
He notes that this cost is that of the drug alone. and does not include doctor’s fees, imaging costs and hospitalizations and other costs encountered by seriously ill patients.
Read the article. Our costs for cancer treatment, like all other modalities of care, are significantly higher than any other country on earth.
Medicynical Note: For patients it’s a case of your money or your life, But the sad truth is that in advanced disease even if the patient is one of those that has some benefit, it is both. The question is how much can an individual or health care system afford?