Medicynic

Another study of bevacizumab (Avastin), this time in lung cancer, showing minimal to no improvement in outcomes with treatment.  Remember this drug costs in the range of $80-100,000/year.

In a study being published this week in the Journal of the American Medical Association, those treated with bevacizumab and chemotherapy did not live significantly longer than those simply treated with chemo.

Patients aged 65 and older who received Avastin in addition to a standard chemotherapy regimen had a median overall survival of 9.7 months, according to the study to be published tomorrow in the Journal of the American Medical Association. While that was longer than the 8.9 months and 8 months for two groups of patients receiving chemotherapy only, the finding wasn’t statistically significant, said the researchers from the Dana- Farber Cancer Institute in Boston.

Avastin, a $5.8 billion-a-year product also known as bevacizumab, won U.S. Food and Drug Administration approval for non-small cell lung cancer in 2006, after a study found the therapy improved survival by a median of two months. That research showed no benefit among patients aged 65 and older, who are covered by Medicare, the government health-insurance program for the elderly and disabled. At least two-thirds of patients with lung cancer qualify for Medicare, which has covered Avastin for that use since FDA approval, the authors said.

And:

Patients in the Avastin group had a 39.6 percent probability of surviving one year, compared with 40.1 percent getting chemotherapy from 2006-2007 and 35.6 percent for those treated earlier than 2006, the study found. More recent data might yield different results, the researchers said

Medicynical Note:  Roche may dispute the findings but what is clear is that bevacizumab (Avastin) has a minimal if any beneficial effect in elderly lung cancer patients.

This drug brings in 5.8 billion dollars in revenue to Roche, about the same amount as the cost of malpractice litigation in the U.S. (See previous Medicynic for details)  We’re talking big bucks for a drug with limited benefit. 

We have a non-system of care that costs too much.   Drugs such as bevacizumab (Avastin) are part of the problem.

More here: 

Bevacizumab should not be considered part of the “backbone” of treatment or the standard of care for older patients with advanced disease, said lead author Deborah Schrag, MD, MPH, from the Dana-Farber Cancer Institute in Boston, Massachusetts. She spoke at a press conference, held in Washington, DC, on the journal’s new issue, which centers on comparative effectiveness research.

A recent study being published in Health Affairs written by a fellow of the conservative American Enterprise  Institute and Manhattan Institute and funded by Bristol Meyers Squibb is being criticized as misleading and poorly done.

The study notes:

Cancer patients in the United States who were diagnosed from 1995 to 1999 lived an average 11.1 years after that, compared with 9.3 years for those in 10 countries in Europe, researchers led by health economist Tomas Philipson of the University of Chicago reported in an analysis published Monday in the journal Health Affairs.

Those extra years came at a price. By 1999 (the last year the researchers analyzed), the United States was spending an average of $70,000 per cancer case (up 49 percent since 1983), compared with $44,000 in Europe (up 16 percent). Using standard figures for an extra year of life, the researchers concluded that the value of the U.S. survival gains outweighed the cost by an average $61,000 per case. The greater spending on cancer care in the United States, they conclude, is therefore “worth it.”

But critics believe:

“This study is pure folly,” said biostatistician Dr. Don Berry of MD Anderson Cancer Center in Houston. “It’s completely misguided and it’s dangerous. Not only are the authors’ analyses flawed but their conclusions are also wrong.”

The heart of the problem is that the authors naively forgot about lead time bias and effect of earlier diagnosis of often times benign behaving tumors that would never cause a patient problems.  Since the U.S. has a more aggressive disease screening program and diagnoses more of these benign growths their patients appear to survive longer but the improved survival has nothing to do with treatment benefit.

As the critics note:

If a tumor is diagnosed very early in its existence – if it has a long “lead time” – the patient may survive, say, two years if the tumor is very aggressive. If an identical tumor is found in that patient’s identical twin later, the twin will survive, say, six months. But the twins die at the same age. The first survived longer with cancer due to lead-time bias, but did not have a longer lifetime.

Crediting medical care with “improving survival” is therefore misleading, cancer experts have long argued. Lead-time bias makes it seem patients live longer, but the only thing that is longer is the number of years they know they have cancer, not their lifespan.

Read the rest of the article to learn more of the flaws of this dangerous biased study.

Medicynical note:  It is not an accident that this study is drug company sponsored and that the results overstate the benefit of treatment.  While there has been some progress in decreasing cancer mortality  it comes mostly from prevention (smoking cessation) and earlier diagnosis. 

What’s most interesting is the amount of money the authors propose as reasonable to spend to extend a person’s live one year—$150,000 to $360,000.  As Ewe Reinhardt notes:

“Are American taxpayers willing to pay $150,000 in added taxes (Medicyncial addition: and insurance premiums) to purchase an added life year for some poor person?” asked health economist Uwe Reinhardt of Princeton University. “Does the urge to cut government spending on Medicare and Medicaid suggest Congress is willing to purchase added life years for anyone who cannot purchase it with his or her own money at a price of $150,000 per year?”

Rather than try and justify our exceptionally expensive and inefficient health care non-system we should be working to find what works best and is the most cost efficient. 

Our problem with health care in the U.S. is that we can’t afford the non-system that we have created.  It’s a monster that’s eating us alive.