By MATTHEW HERPER
The U.S. approved 33% more new cancer drugs than European nations including the United Kingdom, France, and Germany between 2000 and 2011, and approved them much faster as well,
according to new research released today by the Tufts Center for the Study of Drug Development.
But Americans pay for their greater access to new medicines. The cancer drugs, on average, cost 9% less in Europe. Those costs are absorbed mostly by governments and insurance companies, though U.S. health plans are more likely to make patients pay, on average, 23% or more of the price. That can cost individual cancer patients. Further complicating comparisons, and not part of the study, drug companies often work to help patients with these out-of-pocket (and bank account, and mortgage) costs.
There is no evidence as to whether the increased access to new drugs and the higher costs translate into better results for cancer patients or not.
From Tufts’ press release:
“While greater access to more treatment options is definitely a positive for patients in the U.S., it is not clear if greater access leads to better health outcomes,” noted Joshua P. Cohen, research assistant professor at Tufts CSDD who conducted the analysis.
He said that the growing use of comparative effectiveness research, which provides information on the relative strengths and weaknesses of different medical technologies, could help close the gap between what is known and what is done in pharmaceutical care.
“Although more oncology drugs are available in the U.S., and the costs for a higher share of them are reimbursed, the evidence-based approach adopted by European systems have improved the affordability of drugs in Europe that are considered to be cost-effective,” Cohen said.
The study was published on the CSDD’s Web site, and was not peer-reviewed for publication in an academic journal, but it still provides a fascinating window into cancer care. Between 2000 and 2011, 40 new cancer medications were approved in the U.S. compared to 30 in the European Union countries. Sometimes the time difference in approval is staggering. It took 11 months after the U.S. approval for the E.U. to approve Gleevec, from Novartis, probably one of the most impressive cancer drugs of the entire time period. For Tykerb, it was 15 months. Dendreon’s Provenge, for prostate cancer, and Pfizer‘s Xalkori, for non-small cell lung cancer, are both approved in the U.S. but not in Europe.
Some of this difference is because the Food and Drug Administration is actually pretty speedy when it comes to approving cancer medicines. But some is also because of commercial decisions by drug makers, who decide to target the more lucrative U.S. market first.
The prices of these drugs in Europe are often dramatically lower than in the U.S., which the report says could be because of the negotiating power of single-payer systems over private insurance. Campath costs $1790 in the U.S. (that’s the average selling price +6%) but just $570 in Europe. It’s sold by Sanofi in the U.S. and Bayer in Europe. Erbitux, for colon cancer, costs $1060 in the U.S. but $466 in Europe; it’s sold by Eli Lilly and Bristol-Myers Squibb in the U.S. and Merck KGaA in Europe. (In both cases, the marketing relationships may have something to do with the price difference.)
[Just to be clear, these are the prices for an order of the drug; treating a patient with one can cost significantly more, depending on the number of courses of treatment.]
Newer drugs seem to have less of a price difference. Bristol’s Yervoy, for melanoma, costs $23,800 on both sides of the ocean. And Zevalin, an antibody that is connected to a radioactive drug, costs $2,800 in the U.S. and $4,600 in Europe.