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Costly therapies for hematologic malignancies provide 'reasonable value'
Several high-cost therapies for hematologic malignancies often provide “reasonable value,” according to results of a systematic review.
The median cost per quality-adjusted life-year gained (QALY) ratios for these drugs often fell below benchmarks for cost-effectiveness, results showed.
“Given the increased discussion about the high cost of these treatments, we were somewhat surprised to discover that their cost-effectiveness ratios were lower than expected,” Peter S. Neumann, ScD, director of the Center for Evaluation of Value and Risk in Health at Tufts Medical Center, said in a press release. “Our analysis had a small sample size and included both industry- and non–industry-funded studies. In addition, cost-effectiveness ratios may have changed over time as associated costs or benefits have changed. However, the study underscores that debates in health care should consider the value of breakthrough drugs and not just costs.”
Neumann and colleagues used the Tufts Cost-Effectiveness Analysis Registry to identify 29 cost-effectiveness studies published between 1996 and 2012. Industry funded 22 of these studies (76%).
The studies evaluated nine therapies intended for patients with chronic myeloid leukemia, chronic lymphocytic leukemia, non-Hodgkin’s lymphoma and multiple myeloma. The therapies were: alpha interferon, Campath (alemtuzumab, Genzyme), Treanda (bendamustine, Cephalon), Velcade (bortezomib, Millennium Pharmaceuticals), Sprycel (dasatinib, Bristol Myers Squibb), Gleevec (imatinib, Novartis), Revlimid (lenalidomide, Celgene), Rituxan (rituximab, Genentech/Biogen Idec) and Thalomid (thalidomide, Celgene),
Researchers compared the QALY ratios reported in each study.
Overall, studies that evaluated therapies for CML had the highest median ratio ($55,000/QALY), whereas therapies for non-Hodgkin’s lymphoma had the lowest median ratio ($21,500/QALY).
Median ratios also were lower for industry-funded than non–industry-funded studies ($26,000/QALY vs. $33,000/QALY).
The median cost-effectiveness ratios tended to vary across time periods. The ratio increased from $35,000/QALY between 1996 to 2002 to $52,000/QALY in 2003 and 2006, but then decreased again to $22,000/QALY between 2007 and 2012.
Researchers then compared these ratios with benchmarks commonly used in the United States to determine cost-effectiveness. A majority of the median ratios fell below the $100,000/QALY (86%) and $50,000/QALY (73%) benchmarks.
Four ratios exceeded $100,000/QALY. These included two that applied to Velcade for multiple myeloma, one to interferon alpha for CML, and one to Gleevec for CML.
“Our review suggests many new treatments for hematologic malignancies may confer reasonable value for money,” Neumann and colleagues wrote. “We believe that this kind of global overview of the literature will be useful to provide a broad perspective for clinicians on how their individual focus relates to associated interventions and malignancies. In the context of recent discussions about the cost-effectiveness of various interventions in the popular media, it may be particularly useful for clinicians to understand the literature in the field as a whole.” – by Alexandra Todak
Disclosure: The Center for the Evaluation of Value and Risk in Health receives government, private foundation and industry research funding. The researchers report no relevant financial disclosures.
Perspective
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There are several important limitations to consider when interpreting the results of this analysis. The researchers evaluated data from 29 studies — 22 of which were funded by the pharmaceutical industry — that examined costs in the treatment of hematologic malignancies. Because of the fact that 76% of the studies were funded by the pharmaceutical industry, we cannot exclude the possibility of a selection bias of papers, as well as an analysis bias of data. Additionally, only nine studies were from the U.S. perspective. The analysis also included studies conducted in the United Kingdom, Norway, Sweden, France, Canada and Finland. The costs of drugs in these countries are different than their costs in the United States. In fact, drug prices are typically lower outside of the United States. Therefore, it is inappropriate to combine these analyses to make conclusions about the cost-effectiveness of drugs in the United States.
Further, each of these studies may include different measurements for independent variables — such as the price of drugs, timespan evaluated, quality of life and patient characteristics — that vary in the studies and color each of their conclusions. For instance, in 2014, the price of imatinib (Gleevec, Novartis) was $132,000, and this should be the price that is considered when determining the drug’s cost-effectiveness. However, the studies examined in this analysis were published between 1996 and 2012, a period during which the cost of imatinib changed drastically. In 2001, imatinib cost about $26,000. In 2012, this figure increased to $92,000. Thus, it is flawed to determine that a drug is cost-effective in 2014 based on its price in 2001.
The justification of high cancer drug prices needs to stop. Our duty as physicians is to protect our patients, and messages like this only harm them.