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by:SAFEKA      2019-08-24
new cancer drugs cost more than $10,000 each monthnew cancer drugs cost more than $10,000 each monthnew cancer drugs cost more than $10,000 each month  -  peg hook price tag
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Is it possible to put a price tag in life?
If so, how much is the life value of a year? A month? A day, even?
These may seem unpleasant or even absurd calculations, but they are beginning to enter the world of cancer care.
We now face an unexpected paradox.
The ability of medicine to treat cancer exceeds our collective ability to pay for cancer treatment.
As treatment becomes more complex, cancer targets become more specific, and costs of survival benefits rise sharply, sometimes weeks or even days higher than previous standards.
Of the 12 new cancer drugs approved in the United StatesS.
In 2012, the Food and Drug Administration priced more than $100,000 a year for 11 patients.
Only 3 patients were found to have an improved survival rate, of which 2 had an improved average survival rate of less than two months.
In Ontario, the provincial government paid for nearly 40 intravenous cancer drugs through the Ontario Cancer Care Center.
In just a decade from 2005 to 2015, the cost of these drugs has almost tripled, from $0. 322 billion a year to $0. 112 billion.
If you take all FDA-approved cancer drugs from 1981 and convert the monthly cost per patient to $2013S.
USD, you will find: for all cancer drugs approved for the period 1981 to 89, an average of $1,110 per patient per month.
For anti-cancer drugs approved from 2011 to 2013, the average monthly cost increased by $10 to $10,800 per patient.
Since the beginning of 2004, the cost of any cancer drug approved by the FDA has been less than $3,100 per month.
Consider some recent examples: Ipilimumab, listed as Yervoy, is approved for late treatment
Stage melanoma, a particularly deadly skin cancer.
The cost of taking four doses within 12 weeks: $120,000.
Overall survival benefits? Just 3.
Average 7 months, no more than treatment time.
There is nivolumab, listed as Opdivo and approved for use in the USS.
Late for treatment in Canadastage melanoma.
Cost per year for patients with an average weight of 70 kilograms: $157,000.
The average time before the disease starts to deteriorate?
A recent clinical trial is less than six months old.
There is now a clinical trial that combines ipilimumab with nivolumab to treat melanoma, and another trial combines these two drugs to treat one lung cancer.
The cost is reported to be $296,000
At the current exchange rate, about $410,000 Cdn-
Based on average 70-kg patient.
To understand the wave of costs affecting health --
Care system, let's do some backupof-the-
Envelope calculations were performed using the example of ipilimumab combined with nivolumab.
In the case of non
The results of small cell lung cancer are relatively impressive, in part because
Late survival period-
The stage of lung cancer is too bad.
Only one of the five patients can live to be five years old.
For example, these two
Drug combinations become the standard for non-drug treatment
Patients with small cell lung cancer.
Let's say conservatively that the cost per patient is $300,000.
In Canada, it is almost impossible to know the actual cost of anti-cancer drugs because the provincial government negotiated confidential rebates with manufacturers.
Approximately 22,600 Canadians are expected to be diagnosed
Small cell lung cancer this year
And if each of them gets these two treatments
The cost of the drug mix will be close to $6. 8 billion. That $6.
8 billion cover the treatment of a lung cancer, about 8 times the total amount of all intravenous cancer drugs used in Canada for each cancer.
We're not far from the first dollar in the world. million-a-
Anti-cancer drugs.
Pembrolizumab is another new immunotherapy approved for the treatment of melanoma.
The drug was approved at a dose of two mg per kilogram of body weight.
But the manufacturer of pembrolizumab is also testing a higher dose of 10 mg per kilogram.
According to data released at last year's American cancer conference, higher doses will eventually cost more than $1 million a year for each average weight patient.
"Looking at the price tag of these products, it does start to raise some serious issues about system sustainability, not just Ontario or Canada, but around the world, scott gawara, director of the provincial drug reimbursement program at the Ontario Cancer Care Center, said.
The issue of sustainable development will only get worse.
Cancer is primarily a disease for the elderly, and with the baby boomers over retirement age, Canada's population is growing and aging.
The number of people diagnosed with cancer is expected to grow by 40 over the next 15 years.
"Now this is a challenge and the future will be a challenge," Gavura said . ".
As costs increase, the government's usual response is to move funds from lowerprofile health-
Nursing programs such as the elderly or mentally ill
"Path to minimal resistance," according to Stephen Birch, an expert in health economics at McMaster University who studies drug costs
Effectiveness strategy.
"With these treatments, the average life span of the patient you're talking about is a few days, so we're going to spend millions of dollars to extend the life span for a few days," Birch said.
"It may be relevant, but what we have to also consider is what could be a replacement for this money and where does it come from?
"Let's not see it as the cost of this versus the cost of this, but the benefit of this versus the benefit that we have to give up on producing it," he added . ".
"So, the benefits are generated compared to before.
"Sustainability, as well as fair and affordable access to new treatments, is an important issue, according to the spokesperson for innovative drugs Canada, an umbrella organization representing more than 50 pharmaceutical companies in the country.
"With the proliferation of innovative oncology treatments, there is no doubt that they provide great value to patients and health --
The nursing system, "said Deputy Secretary-General Glenn Monteith.
President, innovative drug innovation and health system sustainability, Canada.
"We are working not only with public payment systems, but also with private payment systems to find innovative solutions for these drugs," said Monteith . ".
"It's a challenge for all of us, and the other option is that we don't have the drugs available and no one wants them.
"Christopher Longo is a professor at McMaster University business school focusing on health policy and management.
He understands these issues from several unique perspectives.
He has worked in the pharmaceutical industry for 16 years and is now one of 13
The only economist
The Ontario Cancer Drug Steering Committee, which advises the provincial Department of Health.
"When we have unlimited funds, it's not really a problem," Longge said . ".
"But when our funds are limited, we have to say, 'Okay, where are we going to use them? '?
If I spend $100,000 on this to get a month's life, I can't use it in all other cases where I can get more than a month's worth
"We really want to maximize the extra life span we can provide to the community.
"In a thoughtful academic article entitled" How much is the value of life ", American cancer researchers Tito Fojo and Christine Grady directly target the high cost of new therapies, especially those who have little improvement in survival.
"What are the benefits of cancer treatment?
How many cost factors should be considered for consideration?
Who should decide?
"Ask two researchers, they are part of the United States. S.
National Cancer Institute
"As oncologists, we cannot continue without answering these questions.
Fojo and Grady wrote: "In a sense, every life has infinite value, and we naturally avoid the tension between not wanting to give value to life and limited resources.
"But the rising cost of cancer treatment makes this dilemma inevitable.
"They looked at the situation of a new drug called cetuxumab, which was approved for advanced colorectal cancer and also tested in some type of lung cancer.
The trial showed that the overall survival rate increased by 1 with cetuxumab in combination with another drug. 7 months.
In the lung cancer test, the overall survival rate was only increased by 1.
Average 2 months
1 extra fee.
Survive 2 months?
About $80,000.
"If we allow the survival advantage of 1.
The value of 2 months is $80,000, and according to the push method, the survival value of a year is $800,000, and we need $440 billion a year.
Nearly 100 times the National Cancer Institute's budget.
"Every year, the lives of 550,000 Americans who died of cancer are extended for one year," Fojo and Grady said . ".
"No one will be cured.
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Throwing a coin saved Steve Rudaniecki's life.
Until his last few months, at 10-
War of the Year-
Rudaniecki was provided for the last time in the stage of chronic lymphocytes leukemia
Mary's chance
One location in clinical trials at the Juravinski Cancer Center in Hamilton.
Although his swollen lymph nodes became prominent lumps and lumps on his body, his first reaction was a loud negative.
Rudaniecki thought at the time, "I'm not a guinea pig for anyone. go and die . ".
But then my wife and I argued about it, and we cried and talked, and I said, 'Well, I'll try it.
"The trial is aimed at a promising new drug called iludini.
The patients in the trial will receive two types of chemotherapy, known as benzolastine and liptuumab, which are commonly used to kill cancer.
Then there is the medical equivalent of a coin.
Half of the patients in the trial received the capsule-form ibrutinib, three times a day.
Half received it-
Take placebo three times a day.
Neither the patient nor the doctor knows which one.
Rudaniecki quickly guessed which side of the trial he was on.
Almost immediately, the lump and lump began to disappear.
In fact, the results of the ibrutinib were so significant that the global trial stopped prematurely that all patients in the trial who received the placebo took the drug.
In May, he received a phone call from the cancer doctor's office.
The results of the trial have been unlocked and, as he has long suspected, Rudaniecki has been officially informed that he has been receiving Ibrahimovic instead of a placebo.
"She asked me, 'What do you think you're doing?
"She smiled," he said.
"When you see the result of what I was like two years ago, I was like an elephant.
"Where are you going today?
You don't have to be a rocket scientist.
"The story of the north end was first recorded in the audience's 2013-Yard red Cancer series.
Nearly three years have passed and he is still strong.
On the wall of Rudaniecki's house, there is a frame copy of the audience story of November 2013.
The title is "partial mitigation of people described in red code ".
"If I take a placebo, it's most likely a monument on the wall," Rudaniecki said . ".
However, it's not cheap to keep Steve rudanich alive.
Ibrutinib, which sells as Imbruvica's considerable Yang Sen company.
, Approved by Health Canada at the end of last year.
It is believed that the price of Imbruvica is about $100 per grain.
Rudaniecki takes three Imbruvica capsules a day and will take them for the rest of his life, or beat the wood until the drug stops working.
About $9,000 a month, nearly $110,000 a year.
In the case of Rudaniecki, the taxpayer has got rid of the dilemma for his amazing cost of life --
Salvage treatment
As part of his agreement to participate in clinical trials, Janssen Inc.
He offers capsules for free as long as Rudaniecki needs them.
"This requires a lot of coins to be put in," Rudaniecki said . ".
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Why are anti-cancer drugs so expensive?
Psychology certainly works.
"I think this is the fact that we can all get," said Birch, an expert in health economics . ".
"We see colleagues get it, we see neighbors get it, and in many other cases we may feel like we're not vulnerable.
"We know relatively little about cancer, which only contributes to the fear of cancer," he added . ".
"So it doesn't matter if we have a magic pill, wow.
"In addition, the nature of the cancer usually means that intense treatment is needed immediately. "This is a life --and-
"In many cases, deaths and people are willing to pay a lot of money to extend the lives of the people they love," said Long Ge, a professor at McMaster business . ".
"Does it put pressure on health? care system? Yes.
"The usual market supply and demand forces also play a role.
There is an extra feature for cancer.
There is no silver bullet that can eradicate the disease.
The opposite is true.
The treatment of cancer is becoming more and more specialized.
"As pharmaceutical companies are increasingly focused on the treatment of these drugs, their market is also shrinking," said Long Ge . ".
"So when they narrow the market in order to recover their investment, the price will be higher.
"The trial is therefore much more difficult.
"According to Monteith of innovative drugs Canada, this is difficult and expensive.
"The trials have become very complicated," says Monteith . ".
"Because the treatment becomes so specific, they tend to be smaller now.
"You must be as strict as you can --
Or more strict.
In the design and protocol of clinical trials, it is intended for smaller, more targeted treatments than in the past. "Dr.
Bill Evans is the former head of the Juravinski Cancer Center in Hamilton.
He and Pan now-
The Canadian Cancer Drug Review Board (pCODR) examined the safety and cost-effectiveness of all cancer drugs approved for use in Canada, and then made suggestions on reimbursement of public drug programs.
Over the next five years, pCODR is expected to have to review 225 new cancer drugs or drug combinations, Evans said. The U. S.
At the same time, the FDA is aware that more than 700 new cancer drugs are being tested.
"As you get older, you get aging," Evans said . ".
"You may have a heart attack and you may have Alzheimer's, but if you live long enough, you have a high chance of getting cancer. One in three.
"So pharmaceutical companies realize that there are a lot of people who are going to get cancer and we 'd better see what products we can develop," he added . ".
"Cancer has become a big business.
"This is probably the biggest reason for the high cost of cancer drugs --
The intersection of government regulatory framework and marketing strategies in the pharmaceutical industry.
"The challenge is that pharmaceutical companies are very strategic," said Long Ge . ".
"They look at the world market, they look at which countries refer to other countries for pricing, and then they basically arrange their release order to get the highest global price. "The U. S.
The market is one of the most expensive markets, so in general, the United StatesS.
Because it sets the price, it is approved first. "In the U. S.
There is also a confusing question. 22 at play.
Under the law, the FDA does not allow price consideration when deciding whether to approve a new drug.
All that can be considered is the safety and effectiveness of the drug.
According to different laws, medical insurancethe U. S.
Government health insurance program
It is an obligation to bear the costs of any drug approved by the FDA.
Therefore, one party cannot consider the cost and the other cannot avoid paying any set price.
"It's so strange," Evans said . "
"In many ways, the United StatesS.
The way it must be changed.
Congress must amend the law.
"It has to allow the FDA to consider costs.
It must give the opportunity to negotiate health insurance.
Then we will get some real prices.
"However, there is a large, prestigious American cancer hospital that does decide to draw a line on the beach.
Peter Bach and his two colleagues at Memorial Sloan in New York
Kaitlyn cancer center wrote an article.
On October 2012, the New York Times published an ed article.
They wrote a new drug, Zaltrap, approved by the FDA for advanced colorectal cancer.
Compared with Avastin, a similar drug used for the same conditions, Zaltrap is basically equal in terms of efficacy.
However, the cost of Zaltrap is more than twice that of Avastin
Zaltrap is over $11,000 per month while Avastin is over $5,000 per month. In a real-
The world model of American fishing
22. law requires law to pay Zaltrap at the time of regulation because it has been approved by the FDA.
But Bach and his colleagues decided to take a stand, as they explained in the article. Memorial Sloan-
Kaitlyn will not give the patient a new drug Zaltrap, because the high cost is not getting a meager benefit compared to Avastin.
Within a week of the publication of the article, the company producing Zaltrap reduced the price of the drug by 50.
In Canada, the patent drug price review board provides for fees that pharmaceutical companies can charge.
In order to get guidance, the board studied the United StatesS.
Price reference for UK, Germany, Switzerland, Sweden and Italy.
In practice, however, there is a limit on the amount of gradients tolerated in drug prices in North America, because of the U. S.
Be alert to the crossBorder shopping.
"Negotiations may still be limited by the fact that we are sitting next to an elephant who doesn't seem to want to talk about costs," Evans said . ".
"If you have a lot of water between you and the US, you can negotiate better because you don't have to worry about cross-trades
Border transportation of drugs
"So Europeans can negotiate to some extent independently of the United States. S.
Like Australians and New Zealanders, "Evans said.
"We only have the Great Lakes, and its water body is not big enough.
"It's no surprise that there have been attempts to quantify the relationship between treatment costs and the health benefits that patients experience.
Obviously, that makes sense.
We want health.
Spend as little money as possible to get the highest benefit of the care system. One of these measurements is called mass.
Year of life after adjustment, or QALY-
The intervention will increase the number of years of life and will be adjusted according to the increased quality of life.
The premise is that it is important not only to calculate the amount of additional time acquired for a particular treatment, but also to include the quality of the time obtained.
Keeping someone alive, but in pain, or having a new health burden, or in extreme pain, is more important than the treatment to increase survival with a good quality of life.
But computing QALY is an inaccurate science because it is not easy to add a number to the quality of life.
The next one is ice-
Incremental cost-
Efficiency ratio-
This is the dollar figure used to increase the cost of quality --
Years of life after patient adjustment.
Indeed, the ICER value has become an unofficial threshold for receiving or rejecting new treatment.
The UK is a place to try to use ICER calculations as an official threshold.
According to the guidelines set by the state, the cost of treatment per quality of more than £ 30,000
The adjusted life year should be rejected.
You can imagine what's going on, right?
When more and more expensive anti-cancer drugs are not approved for funding, the people who died of cancer and their loved ones caused a stir and began to put political pressure on exceptions.
So, in 2011, the British government set up a dedicated anti-cancer drug fund, which costs £ 0. 2 billion a year to cover expensive exceptions that go beyond the threshold.
Within two years, the fund was used passively.
In last January, the British government announced that the fund would increase to £ 0. 34 billion a year, and even so, about 15 anti-cancer drugs would be removed from the funding list. Here, the pan-
Cancer drug review Canada provides an unofficial threshold of $100,000 per quality
New cancer drugs have adjusted their life years.
"That's how comfortable we are," Evans said . ".
But Evans also pointed out that he began to see anti-cancer drugs for $175,000 to $300,000 per QALY.
Friction is bound to increase, as the government's budget pressures run counter to the need for expensive living for cancer patients and their families --
Stretching treatment.
"It's emotional and very personal," Long Ge said . ". "I get it.
"But to some extent, the government has to make a decision when it comes to considering a bigger situation.
"Media coverage cannot distract them," he said . "
"They have to focus on what is the best use of our money to make sure we can improve the health of as many people as possible.
"Armed yourself against the expensive puzzle of cancer the latest progress in the fatal diagnosis of Hamilton's top researchers click expand pan
Comments on cancer drugs in Canada (pCODR)
Through an objective clinical and economic assessment of new products, provincial and regional governments are assisted in making decisions to fund cancer drugs. The 21-
Members of the expert review committee are made up of pharmacists, economists, patients and cancer doctors. Dr.
Bill Evans of Hamilton, a former head of Juravinski Cancer Center, has been a member of the committee until the expiration of his term in office on October, and as a peer reviewer, he is still associated with pCODR.
PCODR is responsible for reviewing all new intravenous and oral cancer drugs and then making suggestions to all provincial and regional governments, except Quebec, which acts independently.
The committee reviewed all the clinical evidence of drugs from patient trials, which are very technical and full of complex statistics.
The safety of the drug, its benefits to other treatments, and its hazards, such as side effects
All of this takes into account the impact.
Patients also expressed their views on quality of life and other issues.
"Therefore, it is not difficult to consider a drug that extends survival time, improves quality of life, and is less toxic," Evans said . ".
"But it has never been so simple.
"You're trying to piece these things together and say, ultimately, whether there's a net clinical benefit here for patients.
The PCODR committee then considered economic factors that included not only the cost of drug treatment, but also other costs that could be incurred by new treatment.
For example, a certain percentage of patients may eventually be treated in the hospital. effects.
This is an additional fee that must be considered.
The Commission will look at the prices of new drugs for each quality
The adjusted life year takes into account not only the survival time, but also the quality of the patient's additional time.
Evans said that the Commission sometimes signals that a new drug does have net clinical benefits, but not at the price proposed by the manufacturer, which could open the door to negotiations between the government and the drugmaker.
"We don't say what it should be," Evans said . ".
"We just sent a message that it was too expensive.
Steve Booth is an award.
Steve Booth, who won the founder of the highly acclaimed red code program for investigative journalists and viewers, won three National Newspaper Awards and was rated three times as Canadian annual investigative journalist, he was named Ontario annual reporter five times.
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Is it possible to put a price tag in life?
If so, how much is the life value of a year? A month? A day, even?
These may seem unpleasant or even absurd calculations, but they are beginning to enter the world of cancer care.
We now face an unexpected paradox.
The ability of medicine to treat cancer exceeds our collective ability to pay for cancer treatment.
As treatment becomes more complex, cancer targets become more specific, and costs of survival benefits rise sharply, sometimes weeks or even days higher than previous standards.
Of the 12 new cancer drugs approved in the United StatesS.
In 2012, the Food and Drug Administration priced more than $100,000 a year for 11 patients.
Only 3 patients were found to have an improved survival rate, of which 2 had an improved average survival rate of less than two months.
In Ontario, the provincial government paid for nearly 40 intravenous cancer drugs through the Ontario Cancer Care Center.
In just a decade from 2005 to 2015, the cost of these drugs has almost tripled, from $0. 322 billion a year to $0. 112 billion.
If you take all FDA-approved cancer drugs from 1981 and convert the monthly cost per patient to $2013S.
USD, you will find: for all cancer drugs approved for the period 1981 to 89, an average of $1,110 per patient per month.
For anti-cancer drugs approved from 2011 to 2013, the average monthly cost increased by $10 to $10,800 per patient.
Since the beginning of 2004, the cost of any cancer drug approved by the FDA has been less than $3,100 per month.
Consider some recent examples: Ipilimumab, listed as Yervoy, is approved for late treatment
Stage melanoma, a particularly deadly skin cancer.
The cost of taking four doses within 12 weeks: $120,000.
Overall survival benefits? Just 3.
Average 7 months, no more than treatment time.
There is nivolumab, listed as Opdivo and approved for use in the USS.
Late for treatment in Canadastage melanoma.
Cost per year for patients with an average weight of 70 kilograms: $157,000.
The average time before the disease starts to deteriorate?
A recent clinical trial is less than six months old.
There is now a clinical trial that combines ipilimumab with nivolumab to treat melanoma, and another trial combines these two drugs to treat one lung cancer.
The cost is reported to be $296,000
At the current exchange rate, about $410,000 Cdn-
Based on average 70-kg patient.
To understand the wave of costs affecting health --
Care system, let's do some backupof-the-
Envelope calculations were performed using the example of ipilimumab combined with nivolumab.
In the case of non
The results of small cell lung cancer are relatively impressive, in part because
Late survival period-
The stage of lung cancer is too bad.
Only one of the five patients can live to be five years old.
For example, these two
Drug combinations become the standard for non-drug treatment
Patients with small cell lung cancer.
Let's say conservatively that the cost per patient is $300,000.
In Canada, it is almost impossible to know the actual cost of anti-cancer drugs because the provincial government negotiated confidential rebates with manufacturers.
Approximately 22,600 Canadians are expected to be diagnosed
Small cell lung cancer this year
And if each of them gets these two treatments
The cost of the drug mix will be close to $6. 8 billion. That $6.
8 billion cover the treatment of a lung cancer, about 8 times the total amount of all intravenous cancer drugs used in Canada for each cancer.
We're not far from the first dollar in the world. million-a-
Anti-cancer drugs.
Pembrolizumab is another new immunotherapy approved for the treatment of melanoma.
The drug was approved at a dose of two mg per kilogram of body weight.
But the manufacturer of pembrolizumab is also testing a higher dose of 10 mg per kilogram.
According to data released at last year's American cancer conference, higher doses will eventually cost more than $1 million a year for each average weight patient.
"Looking at the price tag of these products, it does start to raise some serious issues about system sustainability, not just Ontario or Canada, but around the world, scott gawara, director of the provincial drug reimbursement program at the Ontario Cancer Care Center, said.
The issue of sustainable development will only get worse.
Cancer is primarily a disease for the elderly, and with the baby boomers over retirement age, Canada's population is growing and aging.
The number of people diagnosed with cancer is expected to grow by 40 over the next 15 years.
"Now this is a challenge and the future will be a challenge," Gavura said . ".
As costs increase, the government's usual response is to move funds from lowerprofile health-
Nursing programs such as the elderly or mentally ill
"Path to minimal resistance," according to Stephen Birch, an expert in health economics at McMaster University who studies drug costs
Effectiveness strategy.
"With these treatments, the average life span of the patient you're talking about is a few days, so we're going to spend millions of dollars to extend the life span for a few days," Birch said.
"It may be relevant, but what we have to also consider is what could be a replacement for this money and where does it come from?
"Let's not see it as the cost of this versus the cost of this, but the benefit of this versus the benefit that we have to give up on producing it," he added . ".
"So, the benefits are generated compared to before.
"Sustainability, as well as fair and affordable access to new treatments, is an important issue, according to the spokesperson for innovative drugs Canada, an umbrella organization representing more than 50 pharmaceutical companies in the country.
"With the proliferation of innovative oncology treatments, there is no doubt that they provide great value to patients and health --
The nursing system, "said Deputy Secretary-General Glenn Monteith.
President, innovative drug innovation and health system sustainability, Canada.
"We are working not only with public payment systems, but also with private payment systems to find innovative solutions for these drugs," said Monteith . ".
"It's a challenge for all of us, and the other option is that we don't have the drugs available and no one wants them.
"Christopher Longo is a professor at McMaster University business school focusing on health policy and management.
He understands these issues from several unique perspectives.
He has worked in the pharmaceutical industry for 16 years and is now one of 13
The only economist
The Ontario Cancer Drug Steering Committee, which advises the provincial Department of Health.
"When we have unlimited funds, it's not really a problem," Longge said . ".
"But when our funds are limited, we have to say, 'Okay, where are we going to use them? '?
If I spend $100,000 on this to get a month's life, I can't use it in all other cases where I can get more than a month's worth
"We really want to maximize the extra life span we can provide to the community.
"In a thoughtful academic article entitled" How much is the value of life ", American cancer researchers Tito Fojo and Christine Grady directly target the high cost of new therapies, especially those who have little improvement in survival.
"What are the benefits of cancer treatment?
How many cost factors should be considered for consideration?
Who should decide?
"Ask two researchers, they are part of the United States. S.
National Cancer Institute
"As oncologists, we cannot continue without answering these questions.
Fojo and Grady wrote: "In a sense, every life has infinite value, and we naturally avoid the tension between not wanting to give value to life and limited resources.
"But the rising cost of cancer treatment makes this dilemma inevitable.
"They looked at the situation of a new drug called cetuxumab, which was approved for advanced colorectal cancer and also tested in some type of lung cancer.
The trial showed that the overall survival rate increased by 1 with cetuxumab in combination with another drug. 7 months.
In the lung cancer test, the overall survival rate was only increased by 1.
Average 2 months
1 extra fee.
Survive 2 months?
About $80,000.
"If we allow the survival advantage of 1.
The value of 2 months is $80,000, and according to the push method, the survival value of a year is $800,000, and we need $440 billion a year.
Nearly 100 times the National Cancer Institute's budget.
"Every year, the lives of 550,000 Americans who died of cancer are extended for one year," Fojo and Grady said . ".
"No one will be cured.
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Throwing a coin saved Steve Rudaniecki's life.
Until his last few months, at 10-
War of the Year-
Rudaniecki was provided for the last time in the stage of chronic lymphocytes leukemia
Mary's chance
One location in clinical trials at the Juravinski Cancer Center in Hamilton.
Although his swollen lymph nodes became prominent lumps and lumps on his body, his first reaction was a loud negative.
Rudaniecki thought at the time, "I'm not a guinea pig for anyone. go and die . ".
But then my wife and I argued about it, and we cried and talked, and I said, 'Well, I'll try it.
"The trial is aimed at a promising new drug called iludini.
The patients in the trial will receive two types of chemotherapy, known as benzolastine and liptuumab, which are commonly used to kill cancer.
Then there is the medical equivalent of a coin.
Half of the patients in the trial received the capsule-form ibrutinib, three times a day.
Half received it-
Take placebo three times a day.
Neither the patient nor the doctor knows which one.
Rudaniecki quickly guessed which side of the trial he was on.
Almost immediately, the lump and lump began to disappear.
In fact, the results of the ibrutinib were so significant that the global trial stopped prematurely that all patients in the trial who received the placebo took the drug.
In May, he received a phone call from the cancer doctor's office.
The results of the trial have been unlocked and, as he has long suspected, Rudaniecki has been officially informed that he has been receiving Ibrahimovic instead of a placebo.
"She asked me, 'What do you think you're doing?
"She smiled," he said.
"When you see the result of what I was like two years ago, I was like an elephant.
"Where are you going today?
You don't have to be a rocket scientist.
"The story of the north end was first recorded in the audience's 2013-Yard red Cancer series.
Nearly three years have passed and he is still strong.
On the wall of Rudaniecki's house, there is a frame copy of the audience story of November 2013.
The title is "partial mitigation of people described in red code ".
"If I take a placebo, it's most likely a monument on the wall," Rudaniecki said . ".
However, it's not cheap to keep Steve rudanich alive.
Ibrutinib, which sells as Imbruvica's considerable Yang Sen company.
, Approved by Health Canada at the end of last year.
It is believed that the price of Imbruvica is about $100 per grain.
Rudaniecki takes three Imbruvica capsules a day and will take them for the rest of his life, or beat the wood until the drug stops working.
About $9,000 a month, nearly $110,000 a year.
In the case of Rudaniecki, the taxpayer has got rid of the dilemma for his amazing cost of life --
Salvage treatment
As part of his agreement to participate in clinical trials, Janssen Inc.
He offers capsules for free as long as Rudaniecki needs them.
"This requires a lot of coins to be put in," Rudaniecki said . ".
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Why are anti-cancer drugs so expensive?
Psychology certainly works.
"I think this is the fact that we can all get," said Birch, an expert in health economics . ".
"We see colleagues get it, we see neighbors get it, and in many other cases we may feel like we're not vulnerable.
"We know relatively little about cancer, which only contributes to the fear of cancer," he added . ".
"So it doesn't matter if we have a magic pill, wow.
"In addition, the nature of the cancer usually means that intense treatment is needed immediately. "This is a life --and-
"In many cases, deaths and people are willing to pay a lot of money to extend the lives of the people they love," said Long Ge, a professor at McMaster business . ".
"Does it put pressure on health? care system? Yes.
"The usual market supply and demand forces also play a role.
There is an extra feature for cancer.
There is no silver bullet that can eradicate the disease.
The opposite is true.
The treatment of cancer is becoming more and more specialized.
"As pharmaceutical companies are increasingly focused on the treatment of these drugs, their market is also shrinking," said Long Ge . ".
"So when they narrow the market in order to recover their investment, the price will be higher.
"The trial is therefore much more difficult.
"According to Monteith of innovative drugs Canada, this is difficult and expensive.
"The trials have become very complicated," says Monteith . ".
"Because the treatment becomes so specific, they tend to be smaller now.
"You must be as strict as you can --
Or more strict.
In the design and protocol of clinical trials, it is intended for smaller, more targeted treatments than in the past. "Dr.
Bill Evans is the former head of the Juravinski Cancer Center in Hamilton.
He and Pan now-
The Canadian Cancer Drug Review Board (pCODR) examined the safety and cost-effectiveness of all cancer drugs approved for use in Canada, and then made suggestions on reimbursement of public drug programs.
Over the next five years, pCODR is expected to have to review 225 new cancer drugs or drug combinations, Evans said. The U. S.
At the same time, the FDA is aware that more than 700 new cancer drugs are being tested.
"As you get older, you get aging," Evans said . ".
"You may have a heart attack and you may have Alzheimer's, but if you live long enough, you have a high chance of getting cancer. One in three.
"So pharmaceutical companies realize that there are a lot of people who are going to get cancer and we 'd better see what products we can develop," he added . ".
"Cancer has become a big business.
"This is probably the biggest reason for the high cost of cancer drugs --
The intersection of government regulatory framework and marketing strategies in the pharmaceutical industry.
"The challenge is that pharmaceutical companies are very strategic," said Long Ge . ".
"They look at the world market, they look at which countries refer to other countries for pricing, and then they basically arrange their release order to get the highest global price. "The U. S.
The market is one of the most expensive markets, so in general, the United StatesS.
Because it sets the price, it is approved first. "In the U. S.
There is also a confusing question. 22 at play.
Under the law, the FDA does not allow price consideration when deciding whether to approve a new drug.
All that can be considered is the safety and effectiveness of the drug.
According to different laws, medical insurancethe U. S.
Government health insurance program
It is an obligation to bear the costs of any drug approved by the FDA.
Therefore, one party cannot consider the cost and the other cannot avoid paying any set price.
"It's so strange," Evans said . "
"In many ways, the United StatesS.
The way it must be changed.
Congress must amend the law.
"It has to allow the FDA to consider costs.
It must give the opportunity to negotiate health insurance.
Then we will get some real prices.
"However, there is a large, prestigious American cancer hospital that does decide to draw a line on the beach.
Peter Bach and his two colleagues at Memorial Sloan in New York
Kaitlyn cancer center wrote an article.
On October 2012, the New York Times published an ed article.
They wrote a new drug, Zaltrap, approved by the FDA for advanced colorectal cancer.
Compared with Avastin, a similar drug used for the same conditions, Zaltrap is basically equal in terms of efficacy.
However, the cost of Zaltrap is more than twice that of Avastin
Zaltrap is over $11,000 per month while Avastin is over $5,000 per month. In a real-
The world model of American fishing
22. law requires law to pay Zaltrap at the time of regulation because it has been approved by the FDA.
But Bach and his colleagues decided to take a stand, as they explained in the article. Memorial Sloan-
Kaitlyn will not give the patient a new drug Zaltrap, because the high cost is not getting a meager benefit compared to Avastin.
Within a week of the publication of the article, the company producing Zaltrap reduced the price of the drug by 50.
In Canada, the patent drug price review board provides for fees that pharmaceutical companies can charge.
In order to get guidance, the board studied the United StatesS.
Price reference for UK, Germany, Switzerland, Sweden and Italy.
In practice, however, there is a limit on the amount of gradients tolerated in drug prices in North America, because of the U. S.
Be alert to the crossBorder shopping.
"Negotiations may still be limited by the fact that we are sitting next to an elephant who doesn't seem to want to talk about costs," Evans said . ".
"If you have a lot of water between you and the US, you can negotiate better because you don't have to worry about cross-trades
Border transportation of drugs
"So Europeans can negotiate to some extent independently of the United States. S.
Like Australians and New Zealanders, "Evans said.
"We only have the Great Lakes, and its water body is not big enough.
"It's no surprise that there have been attempts to quantify the relationship between treatment costs and the health benefits that patients experience.
Obviously, that makes sense.
We want health.
Spend as little money as possible to get the highest benefit of the care system. One of these measurements is called mass.
Year of life after adjustment, or QALY-
The intervention will increase the number of years of life and will be adjusted according to the increased quality of life.
The premise is that it is important not only to calculate the amount of additional time acquired for a particular treatment, but also to include the quality of the time obtained.
Keeping someone alive, but in pain, or having a new health burden, or in extreme pain, is more important than the treatment to increase survival with a good quality of life.
But computing QALY is an inaccurate science because it is not easy to add a number to the quality of life.
The next one is ice-
Incremental cost-
Efficiency ratio-
This is the dollar figure used to increase the cost of quality --
Years of life after patient adjustment.
Indeed, the ICER value has become an unofficial threshold for receiving or rejecting new treatment.
The UK is a place to try to use ICER calculations as an official threshold.
According to the guidelines set by the state, the cost of treatment per quality of more than £ 30,000
The adjusted life year should be rejected.
You can imagine what's going on, right?
When more and more expensive anti-cancer drugs are not approved for funding, the people who died of cancer and their loved ones caused a stir and began to put political pressure on exceptions.
So, in 2011, the British government set up a dedicated anti-cancer drug fund, which costs £ 0. 2 billion a year to cover expensive exceptions that go beyond the threshold.
Within two years, the fund was used passively.
In last January, the British government announced that the fund would increase to £ 0. 34 billion a year, and even so, about 15 anti-cancer drugs would be removed from the funding list. Here, the pan-
Cancer drug review Canada provides an unofficial threshold of $100,000 per quality
New cancer drugs have adjusted their life years.
"That's how comfortable we are," Evans said . ".
But Evans also pointed out that he began to see anti-cancer drugs for $175,000 to $300,000 per QALY.
Friction is bound to increase, as the government's budget pressures run counter to the need for expensive living for cancer patients and their families --
Stretching treatment.
"It's emotional and very personal," Long Ge said . ". "I get it.
"But to some extent, the government has to make a decision when it comes to considering a bigger situation.
"Media coverage cannot distract them," he said . "
"They have to focus on what is the best use of our money to make sure we can improve the health of as many people as possible.
"Armed yourself against the expensive puzzle of cancer the latest progress in the fatal diagnosis of Hamilton's top researchers click expand pan
Comments on cancer drugs in Canada (pCODR)
Through an objective clinical and economic assessment of new products, provincial and regional governments are assisted in making decisions to fund cancer drugs. The 21-
Members of the expert review committee are made up of pharmacists, economists, patients and cancer doctors. Dr.
Bill Evans of Hamilton, a former head of Juravinski Cancer Center, has been a member of the committee until the expiration of his term in office on October, and as a peer reviewer, he is still associated with pCODR.
PCODR is responsible for reviewing all new intravenous and oral cancer drugs and then making suggestions to all provincial and regional governments, except Quebec, which acts independently.
The committee reviewed all the clinical evidence of drugs from patient trials, which are very technical and full of complex statistics.
The safety of the drug, its benefits to other treatments, and its hazards, such as side effects
All of this takes into account the impact.
Patients also expressed their views on quality of life and other issues.
"Therefore, it is not difficult to consider a drug that extends survival time, improves quality of life, and is less toxic," Evans said . ".
"But it has never been so simple.
"You're trying to piece these things together and say, ultimately, whether there's a net clinical benefit here for patients.
The PCODR committee then considered economic factors that included not only the cost of drug treatment, but also other costs that could be incurred by new treatment.
For example, a certain percentage of patients may eventually be treated in the hospital. effects.
This is an additional fee that must be considered.
The Commission will look at the prices of new drugs for each quality
The adjusted life year takes into account not only the survival time, but also the quality of the patient's additional time.
Evans said that the Commission sometimes signals that a new drug does have net clinical benefits, but not at the price proposed by the manufacturer, which could open the door to negotiations between the government and the drugmaker.
"We don't say what it should be," Evans said . ".
"We just sent a message that it was too expensive.
Steve Booth is an award.
Steve Booth, who won the founder of the highly acclaimed red code program for investigative journalists and viewers, won three National Newspaper Awards and was rated three times as Canadian annual investigative journalist, he was named Ontario annual reporter five times.
sbuist@thespec. com 905-526-3226 . lb-loader,. lightbox{text-align:center; line-height:0}body:after{content:url(. . /img/close. png)url(. . /img/loading. gif)url(. . /img/prev. png)url(. . /img/next. png); display:none}. lb-
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Is it possible to put a price tag in life?
If so, how much is the life value of a year? A month? A day, even?
These may seem unpleasant or even absurd calculations, but they are beginning to enter the world of cancer care.
We now face an unexpected paradox.
The ability of medicine to treat cancer exceeds our collective ability to pay for cancer treatment.
As treatment becomes more complex, cancer targets become more specific, and costs of survival benefits rise sharply, sometimes weeks or even days higher than previous standards.
Of the 12 new cancer drugs approved in the United StatesS.
In 2012, the Food and Drug Administration priced more than $100,000 a year for 11 patients.
Only 3 patients were found to have an improved survival rate, of which 2 had an improved average survival rate of less than two months.
In Ontario, the provincial government paid for nearly 40 intravenous cancer drugs through the Ontario Cancer Care Center.
In just a decade from 2005 to 2015, the cost of these drugs has almost tripled, from $0. 322 billion a year to $0. 112 billion.
If you take all FDA-approved cancer drugs from 1981 and convert the monthly cost per patient to $2013S.
USD, you will find: for all cancer drugs approved for the period 1981 to 89, an average of $1,110 per patient per month.
For anti-cancer drugs approved from 2011 to 2013, the average monthly cost increased by $10 to $10,800 per patient.
Since the beginning of 2004, the cost of any cancer drug approved by the FDA has been less than $3,100 per month.
Consider some recent examples: Ipilimumab, listed as Yervoy, is approved for late treatment
Stage melanoma, a particularly deadly skin cancer.
The cost of taking four doses within 12 weeks: $120,000.
Overall survival benefits? Just 3.
Average 7 months, no more than treatment time.
There is nivolumab, listed as Opdivo and approved for use in the USS.
Late for treatment in Canadastage melanoma.
Cost per year for patients with an average weight of 70 kilograms: $157,000.
The average time before the disease starts to deteriorate?
A recent clinical trial is less than six months old.
There is now a clinical trial that combines ipilimumab with nivolumab to treat melanoma, and another trial combines these two drugs to treat one lung cancer.
The cost is reported to be $296,000
At the current exchange rate, about $410,000 Cdn-
Based on average 70-kg patient.
To understand the wave of costs affecting health --
Care system, let's do some backupof-the-
Envelope calculations were performed using the example of ipilimumab combined with nivolumab.
In the case of non
The results of small cell lung cancer are relatively impressive, in part because
Late survival period-
The stage of lung cancer is too bad.
Only one of the five patients can live to be five years old.
For example, these two
Drug combinations become the standard for non-drug treatment
Patients with small cell lung cancer.
Let's say conservatively that the cost per patient is $300,000.
In Canada, it is almost impossible to know the actual cost of anti-cancer drugs because the provincial government negotiated confidential rebates with manufacturers.
Approximately 22,600 Canadians are expected to be diagnosed
Small cell lung cancer this year
And if each of them gets these two treatments
The cost of the drug mix will be close to $6. 8 billion. That $6.
8 billion cover the treatment of a lung cancer, about 8 times the total amount of all intravenous cancer drugs used in Canada for each cancer.
We're not far from the first dollar in the world. million-a-
Anti-cancer drugs.
Pembrolizumab is another new immunotherapy approved for the treatment of melanoma.
The drug was approved at a dose of two mg per kilogram of body weight.
But the manufacturer of pembrolizumab is also testing a higher dose of 10 mg per kilogram.
According to data released at last year's American cancer conference, higher doses will eventually cost more than $1 million a year for each average weight patient.
"Looking at the price tag of these products, it does start to raise some serious issues about system sustainability, not just Ontario or Canada, but around the world, scott gawara, director of the provincial drug reimbursement program at the Ontario Cancer Care Center, said.
The issue of sustainable development will only get worse.
Cancer is primarily a disease for the elderly, and with the baby boomers over retirement age, Canada's population is growing and aging.
The number of people diagnosed with cancer is expected to grow by 40 over the next 15 years.
"Now this is a challenge and the future will be a challenge," Gavura said . ".
As costs increase, the government's usual response is to move funds from lowerprofile health-
Nursing programs such as the elderly or mentally ill
"Path to minimal resistance," according to Stephen Birch, an expert in health economics at McMaster University who studies drug costs
Effectiveness strategy.
"With these treatments, the average life span of the patient you're talking about is a few days, so we're going to spend millions of dollars to extend the life span for a few days," Birch said.
"It may be relevant, but what we have to also consider is what could be a replacement for this money and where does it come from?
"Let's not see it as the cost of this versus the cost of this, but the benefit of this versus the benefit that we have to give up on producing it," he added . ".
"So, the benefits are generated compared to before.
"Sustainability, as well as fair and affordable access to new treatments, is an important issue, according to the spokesperson for innovative drugs Canada, an umbrella organization representing more than 50 pharmaceutical companies in the country.
"With the proliferation of innovative oncology treatments, there is no doubt that they provide great value to patients and health --
The nursing system, "said Deputy Secretary-General Glenn Monteith.
President, innovative drug innovation and health system sustainability, Canada.
"We are working not only with public payment systems, but also with private payment systems to find innovative solutions for these drugs," said Monteith . ".
"It's a challenge for all of us, and the other option is that we don't have the drugs available and no one wants them.
"Christopher Longo is a professor at McMaster University business school focusing on health policy and management.
He understands these issues from several unique perspectives.
He has worked in the pharmaceutical industry for 16 years and is now one of 13
The only economist
The Ontario Cancer Drug Steering Committee, which advises the provincial Department of Health.
"When we have unlimited funds, it's not really a problem," Longge said . ".
"But when our funds are limited, we have to say, 'Okay, where are we going to use them? '?
If I spend $100,000 on this to get a month's life, I can't use it in all other cases where I can get more than a month's worth
"We really want to maximize the extra life span we can provide to the community.
"In a thoughtful academic article
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