Can you put a price tag on the life of a prostate cancer patient?
With the advent of Provenge, the first-ever vaccine cancer treatment, that tag has been set at about $23,000 per month of life gained -- $93,000 in total for a treatment that extends life, on average, by four months.
Given already skyrocketing health care costs, the nearly-six-figure cost of Provenge has raised concerns among health care experts, but to those men who have benefited from this revolutionary new therapy, it's worth every penny.
"On a general basis, to survive is worth anything," says Bob Feutz, 84, of Redmond, Washington.
Feutz received Provenge in 2007 as part of a clinical trial after other hormone therapy and 38 sessions of radiation failed to control his prostate cancer adequately.
Provenge, unlike his radiation treatments, caused him nearly no side effects, just two short bouts of chills, during the three sessions needed. While his PSA level -- a test that helps gauge the presence of prostate cancer -- was over five before treatment, in the three years since it has steadily dropped to .69.
"I'm happy to be alive," he says.
Frank Notaris, a 77-year-old Brooklyn native, feels the same way. He just went through treatment a few months ago, but says that "if it keeps you alive, I think it's absolutely worth the cost. Hopefully the insurance companies will cover it."
But given the skyrocketing cost of health care, that cost, multiplied by the thousands of patients each year who could qualify for the treatment, raises concerns for some health policy experts.
The revolutionary technology responsible for the first vaccine for cancer treatment was 15 years in the making, says Mitchell Gold, president and CEO of Dendreon, the company that produces Provenge.
"It was a laborious process. We had to raise $1.2 billion to support the development. I think we've come up with a price that's acceptable. It's priced fairly for the value we're providing to the patients."
Gold says that the cost of Provenge was based on the "overall landscape" of treatment prices for cancer. More specifically, the comparable chemotherapy for advanced stage prostate cancer patients, Taxotere, ends up costing about $23,000 per month of life extended by the treatment.
This was used, in part, to set the price of Provenge -- four months, on average, of extended survival comes out to about the $93,000 price tag.
Provenge for Prostate Cancer: Life at Any Price?
Given that Provenge only takes three sessions of treatment over the course of a month, and causes few side effects, Gold says it provides "increased value" when compared to chemotherapy, which takes months and causes fatigue, nausea, and other side effects.
But does setting the price on par with other similarly costly cancer treatments make it a "fair" price?
"Fairness has nothing to do with it," says David Howard, assistant professor in the department of Health Policy and Management at Emory's Rollins School of Public Health.
Because cancer treatment is usually covered by insurance, not the patient, pharmaceutical companies don't have to answer to the budgets of consumers when pricing.
"If they charge a million dollars that might be so ridiculous that it wouldn't be covered, but otherwise they have a pretty broad range," Howard says. This is one reason there has been a gradual uptick in the price of cancer treatments, he says.
Every year, a "ridiculous" price for a new treatment comes out, and "it's high but in the same ballpark as last year's high-priced treatment. It's an upward ratcheting of what's the maximum acceptable price," Howard says.
And while patients don't normally have to answer to this price, health insurance companies and Medicare do.
An estimated 200,000 new cases of prostate cancer will be diagnosed in 2010, according to the National Cancer Institute. While only a fraction of these cases will ever become eligible for treatment with Provenge, the potential burden on Medicare funds is sizable.
Currently, Medicare is not allowed to deny a treatment based on cost alone, but in the coming years, "it will be difficult to sustain coverage of these very costly procedures considering the Medicare program is facing a huge long-term deficit," Howard says.
"Ten years, 20 years down the road, Congress is going to have to rewrite the law to allow cost to play into coverage decisions."
Medicare Decisions, Future Coverage
While some local Medicare providers already cover Provenge, Medicare nationally will be taking a year to review the product before offering it unilaterally, a caution that Howard says is most likely due to the high cost.
But while $93,000 for four months of treatment seems like a lot, the benefit provided to patients and the revolutionizing technology brought to the fore by Provenge makes it worthwhile, says Dr. Anna Ferrari, professor in the Department of Medicine at NYU Langone Medical Center.
Chemotherapy kills cells new cells in the body in order to attack cancer cells. But Provenge works by boosting the patient's own immune system and training it to attack invader cancer cells specifically.
Provenge was approved by the FDA for use in patients with advanced, hormone therapy-resistant prostate cancer in April, following the positive results of a study Ferrari co-authored.
That study, published in the New England Journal of Medicine Wednesday, found that, on average, patients taking Provenge survived 4.1 months longer than those who took a placebo, and did so with significantly fewer side effects than normally seen with chemotherapy or radiation treatments.
The treatment is custom-made from a patient's own blood. The patient's immune system factors are mixed with an immuno-boosting agent and prostate cancer-specific antigen that make up Provenge. The vaccine is then returned to the patient's body where it incorporates into the body's immune system.
This immunological attack on treating advanced cancer is groundbreaking Ferrari says, and "provides a completely new weapon for cancer, with minimum toxicity." It is a development that may lead to similar treatments for other common cancers, such as breast cancer, she adds.
"I'm very optimistic that this will open a whole new venue for cancer treatment with hardly any side effects," she says.