May 2

Drs. S. Vincent Rajkumar and Jean Luc Harousseau

Drs. Vincent Rajkumar and Jean Luc Harousseau are celebrated multiple myeloma doctors. Multiple myeloma is an incurable blood cancer that can be treated with very expensive drugs. Rajkumar and Harousseau explain the impact of high drug prices on patients, and what can be done to lower them. They point out:

“Attempts to change any of these policies are met with aggressive resistance not only from pharmaceutical companies (which is to be expected) but from many other quarters including professional and patient support organizations all of whom have significant financial conflicts of interest. In short, there are few allies in the fight to lower drug prices…Change in existing law will not be possible without strong advocacy and a patient-driven grass-roots movement.”

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Abstract

Advances in the diagnosis and treatment of multiple myeloma have come at a rapid pace, especially with several new drugs entering the market in the last few years. However, access to and affordability of new treatments poses a major challenge, both in the United States and around the world. High costs of life-saving drugs are detrimental to both the personal finances of the individual patient, as well as society which must bear the increasing costs in terms of increased health insurance premiums, taxes, or both. The challenges are not unique to myeloma, but are commonly encountered in several other cancers as well. But to some extent these pharmacoeconomic concerns are amplified in myeloma due to the need for multidrug regimens that combine 2 or more expensive new drugs, continuous therapy, and the prolonged disease course in most patients. We examine current myeloma therapy from a pharmacoeconomic perspective, and discuss the costs involved. We outline the underlying reasons why cancer drugs are so expensive, the measures that are required to lower cost, and propose potential ways in which costs can be reduced while still delivering high-quality care.

Introduction

There have been major advances in the last 15 years in the diagnosis and treatment of multiple myeloma.1,2 Overall survival has improved remarkably during this period driven by discovery of several new active drugs. However, as in every other malignancy, new drugs come with a hefty price tag: almost every approved cancer drug in the last few years costs more than $100 000 per year in the United States, and myeloma treatments are no exception.3,4 Even the price of old drugs such as melphalan has increased greatly over time. The problem of cost and affordability is amplified in myeloma in 3 ways. First, the disease requires multidrug combinations, increasing the already expensive cost of care to unsustainable levels.5,6 Second, treatments are usually continued until progression in the form of “continuous therapy” or “maintenance therapy,” ensuring that high costs are not a temporary problem but rather an unrelenting dilemma for the patient.7,8 Third, as survival has improved markedly (median of >7-10 years for standard-risk patients), the cumulative costs of care over the lifetime of a patient are exorbitant.9

The high cost of cancer care not only impacts the patient directly but also has an impact on society in the form of rising premiums, taxes, or both. In many countries, high costs limit access to effective drugs, as neither the health care system nor the individual patient can afford these costs without cutting back on other essential needs.10⇓-12 In this Perspective, we outline the current state of myeloma therapy and discuss the costs involved. We summarize the primary reasons why cancer drugs are so expensive, and list some measures that are required to lower cost. We also propose potential ways in which costs can be reduced in myeloma while still delivering high-quality care, and provide recommendations for strategic clinical trials.