High costs of leukemia may be harming patients

The increasing cost of treatments for chronic myeloid leukemia (CML) in the United States has reached unsustainably high levels and may be leaving many patients under- or untreated because they cannot afford care, according a recent article supported by nearly 120 CML experts from more than 15 countries on five continents.

CML was selected as the focus of the piece because it is now considered a highly curable disease, thanks to the emergence of powerful, targeted CML therapies known as tyrosine kinase inhibitors (TKIs) that allow patients to manage their disease with few symptoms by taking a well-tolerated pill. Since the introduction of TKI therapy more than a decade ago, the annual mortality of patients with this disease has declined from 10% to 20% in the early 2000s to just 2% today and the estimated 10-year survival of CML patients has increased from 20% to more than 80%. Patients with CML, who were once told at diagnosis that they had a grim prognosis, are now enjoying close to normal life spans as long as they receive and adhere to prescribed treatments.

"Patients with CML have a much better outlook today than ever before, thanks to advances that have greatly improved survival rates. But these patients now face dire financial struggles as they try to maintain their treatment regimen with the drastically inflating cost of care. And this issue likely extends to patients with other types of cancer who require ongoing treatment to maintain therapeutic benefit," said corresponding author Hagop Kantarjian, MD, Chairman, Department of Leukemia at The University of Texas MD Anderson Cancer Center in Houston. The article was published in Blood (2013; doi:10.1182/blood-2013-03-490003).

Kantarjian and colleagues noted that newly approved CML treatments in the US are priced substantially higher than older options, and the trend is consistent among other cancer types. For example, of the 12 drugs approved by the US Food and Drug Administration for various cancer indications in 2012, 11 were priced above $100,000 per year. Monthly cancer drug prices today (more than $10,000 per month on average) have almost doubled from just a decade ago, when they averaged $5,000 per month.

"A major question we need to answer is how to determine the 'right' price for these drugs. In many cases, it makes sense to let the market govern the price; however, when a product is directly related to a patient's survival over a period of years, it is critical to set a price that allows companies to profit and ensures that patients can afford their treatment," said Kantarjian. "Since CML treatments must be taken on an ongoing basis, we are concerned that the surging prices are potentially harming patients."

"Identifying better ways to manage the cost of cancer care will require an evolution in thinking about current pricing-related policies and regulations, including those that limit price negotiation for Medicare coverage of treatments, as well as patent-related laws that limit the introduction of more affordable generic drugs," said Kantarjian.


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