More pressure to justify cost of cancer drugs versus benefits

 

Medical providers have begun to think more about cost, as well as safety and effectiveness, when they decide on cancer treatments.

 

In the past, pharmaceutical companies could launch a high-priced drug with little push back. But now, there is more pressure from insurers as well as doctors to justify using drugs that provide only incremental benefits. Products that offer clear-cut advances in treatment, however, still command premium prices.

 

The pressure on costs is likely to accelerate. The U.S. Affordable Care Act includes several provisions aimed at improving the value of healthcare, including paying hospitals for the quality of care rather than the quantity.

 

"It's a sign of the times," said Mark Mynhier, partner, healthcare industries advisory at PricewaterhouseCoopers PwC. "We are in fact in a significantly financially challenging environment."

 

Four-fifths of U.S. health insurers recently polled by PwC now require evidence of cost savings or a clear clinical benefit to include new products on their lists of covered drugs.

 

Doctors at New York's Memorial Sloan-Kettering Cancer Center decided in November not to use Zaltrap, a new $11,000 a month colon cancer drug, because it has a "modest" impact on survival, works no better than Avastin, a similar but cheaper competitor, and has worse side effects.

 

Sanofi SA, according to the hospital, responded by offering the drug to all health providers at a 50 percent discount to its wholesale price.

 

The Manhattan cancer center still does not include Zaltrap on its list of available drugs. Sanofi and Regeneron, which helped develop and also sells the drug, both declined to comment.

 

"In order to warrant the price, you are going to have to have better overall survival," said Rhonda Greenapple, chief executive at Reimbursement Intelligence, a consulting firm specializing in medical reimbursement.

 

Linking value to patient outcomes - mainly a drug's impact on survival - is particularly important in oncology, where treatment costs can total tens of thousands of dollars a year.

 

"In cases where there are co-pays, they really do effect the consumer," Mynhier said. "Patients are saying 'I can't afford to pay 10 or 20 percent of a $100,000 therapy.'"

 

WellPoint Inc, the second-largest U.S. health insurer by market value, said it is increasing the amount it pays for less expensive generic cancer drugs as an incentive for doctors to use them.

 

 

"COKE DIDN'T WORK, SO LET'S TRY PEPSI"


Zaltrap was approved in August by the Food and Drug Administration after a study found it improved survival, in combination with chemotherapy, by 1.4 months in colon cancer patients who had stopped responding to chemo.


That is the same benefit seen with Avastin, sold by Roche Holding AG for around $5,000 a month, or about half the price of Zaltrap.


NCCN guidelines say either one or the other drug should be used, not both, but Dr Saltz said most Zaltrap use is likely in patients who were already treated with Avastin - a practice that insurers will eventually stop.


"It's like saying Coke didn't work so let's try Pepsi," he said.


As scientists unravel the biological underpinnings of cancer cells, new targeted therapies are being developed, but the process is expensive.


Dr. Saltz said the solution might just be to walk away from drugs with small, incremental benefits.


"We simply can't afford to pay these very, very large amounts for drugs that offer most people very small benefit," Dr Saltz said. "We haven't figured out how to rein it in."

Humans made cheese 7,500 years ago


Scientists have found the earliest evidence of prehistoric cheese-making from a study of 7,500-year-old pottery fragments that are perforated just like modern cheese strainers.

Milk production and dairy processing allowed early farmers to produce food without slaughtering precious livestock, and making cheese turned milk into a less perishable food that was more digestible for a population who at the time would have been intolerant to the lactose contained in milk.

Researchers from the University of Bristol in Britain, with colleagues in the United States and Poland, analyzed fatty acids embedded in prehistoric pottery from the Polish region of Kuyavia, and found they had been used to separate milk into fat-rich curds for cheese and lactose-containing whey.

"The presence of milk residues in sieves ... constitutes the earliest direct evidence for cheese-making," said Mélanie Salque from Bristol, one of the authors of the research, which was published in the journal Nature.

Peter Bogucki, another researcher involved in the work, said: "Making cheese allowed them to reduce the lactose content of milk, and we know that, at that time, most of the humans were not tolerant to lactose."

Milk residues have been found at ancient sites up to 8,000 years old in Turkey and Libya, but there was no evidence that the milk had been processed into cheese.

Until now, the earliest evidence of cheese-making came from depictions of milk processing in murals several thousand years younger than the pottery fragments.

The researchers believe other vessels found in the same region were used for other specific purposes. Jars lined with beeswax were probably for storing water, and pottery containing the remnants of carcass fats was probably used for cooking meat.

"It is truly remarkable, the depth of insights into ancient human diet and food processing technologies these ancient fats preserved in archaeological ceramics are now providing us with," said Richard Evershed, who heads the Bristol team.