"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."
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.