People: Doctors, surgeons, nurses, and other healthcare professionals who work with cancer patients are highly trained and specialized in their field of study. The high cost of anticancer drugs is linked to numerous factors. It is very expensive to move findings from the bench to the head of the bed and complete all regulatory studies (including phase 1, 2, and 3 clinical trials) for approval. Second, because most cancers are incurable, patients receive treatment with each approved agent (sequentially or in combination), creating a virtual monopoly because the use of one drug does not automatically mean that the others are no longer needed.
Third, even when the monopoly is broken with the arrival of “new and improved versions” of an approved drug, the older (and now generic) drug tends to be considered a poor treatment, thus perpetuating the situation. Fourth, the very nature of cancer and the severity of the diagnosis play a role in that patients and physicians are often willing to pay the high price of treatment, even for marginal improvements in outcomes. Finally, our systems offer an incentive to administer more chemotherapy, and there are legal barriers that prevent agencies such as the FDA from considering economic and cost-effectiveness considerations when approving new drugs. It can be argued that a monopoly as described earlier in this document would be temporary at best because similar drugs of the same class would eventually emerge, offering competition that, in theory, should act as a price check.
However, due to some of the factors described hereinabove, the price check offered by generics in non-malignant diseases is effectively neutralized in the case of cancer. For example, in non-malignant diseases, a new and improved treatment that simply offers incremental benefits over the established treatment, but costs considerably more than the generic version, will not be able to maintain a high price if the incremental benefits do not provide value to the patient. Patients and doctors will switch to less expensive, but almost as effective treatments. However, in the case of life-threatening cancer, because the choice of the new drug is generally associated with metrics such as “superior responses”, improved progression-free survival, and “longer overall survival”, the implications are compounded and the older drug is quickly seen as poor quality treatment.
Examples of this in cancer include thalidomide (Thalomid; Celgene Corp, Summit, NJ) versus the more recent analogue lenalidomide (Revlimid; Celgene Corp); imatinib mesylate (Gleevec; Novartis Pharmaceuticals Corp, East Hanover, NJ) versus nilotinib (Tasigna; Novartis Pharmaceuticals Corp); doxorinib rubicin (Adriamycin; Bedford Laboratories, Bedford, OH or Rubex; Bristol Myers Squibb, New York, NY) vs. liposomal doxorubicin (Doxil; in the U. S., Caelyx; outside the U. S., Janssen Products, a unit of Johnson & Johnson and Myocet; Enzon Pharmaceuticals Inc., Piscataway NJ); and paclitaxel (Taxol; Bristol Myers Squibb Co., New York NY) versus protein-bound paclitaxel (Abraxane; Celgene Corp).
New versions of older anticancer drugs do not become alternatives that generate real competition for price. Instead, these new versions eventually become substitutes for older drugs, maintaining a monopoly. Cheaper generic versions that survive in non-malignant diseases through a variety of maneuvers become obsolete and obsolete when it comes to cancer. The debate over value-based pricing in the United States (if it reaches a national level) for anticancer drugs is likely to be long and arduous.
Phrases like “death panels” and “disconnect” grandma can still be heard echoing in political discourse, and the discussion surrounding the Supreme Court's decision to maintain the individual mandate as part of congressional taxing powers will continue to stir up the debate this election year. Therefore it is unlikely that a price system such as Germany's will be enacted in the United States. However allowing Centers for Medicare and Medicaid Services to negotiate payments for drugs devices and interventions has potential to reduce health spending as it has in other countries. An argument against price controls and value-based prices is that they run counter to free market principles and pricing based on supply and demand.
We have already shown in first section how cancer care is not representative of a “free market system” and traditional checks and balances that make free market system work so efficiently in all other areas are absent when it comes to most cancer treatments. Another concern is that pharmaceutical companies may refuse to lower prices and deprive American patients of new and potentially interesting treatments. We believe this is unlikely according to Organization for Economic Cooperation and Development an organization comprised of high-income developed countries that defines itself as committed to democracy and market economy total expenditure on pharmaceuticals and other non-durable goods per capita is highest in United States among member countries43 United States is large market if not largest and other nations Organization for Economic Cooperation and Development have strong drug price regulations We believe pharmaceutical companies would still introduce these drugs United States due size our market negotiate lower price enter As incredulous this may seem seems happening UK Learn Bach44 suggest pharmaceutical companies have received approval pemetrexed Alimta Eli Lilly & Co Indianapolis IN UK reducing price thus improving profitability pemetrexed Alimta become part National Institute Health Clinical Excellence ICER Thresholds Approval New drugs aren't only aspect cancer care getting expensive Costs associated doctors' salaries diagnostic tests radiation therapy surgery rising says Darius Lakdawalla health economist University Southern California Los Angeles Collectively continue account bulk spending cancer care Despite small share health costs relative other health services anticancer drugs have major impact lives cancer patients Since beginning “war cancer”.
