Avastin - Worth the Cost?

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New York Times July 6, 2008 - Despite a price that can reach $100,000 a year, Avastin has become one of the most popular cancer drugs in the world. In 2007, sales of the drug reached $3.5 billion, with $2.3 billion in the United States. But studies show the drug prolongs life by only a few months, if that. And some newer studies suggest the drug might be less effective against cancer than the FDA believed when the drug was approved. Avastin also has serious, if infrequent, side effects, some of which can be lethal. And because it is almost always used with standard chemotherapy, patients on Avastin also face chemotherapy’s side effects. If Avastin were inexpensive, or if it truly held cancer at bay, few might care. But Avastin raises troubling questions. What does it mean to say the drug works? Is slowing the growth of tumors enough if life is not significantly prolonged or improved? How much evidence should there be before billions of dollars are spent on a drug? And when should cost be factored into the equation? Some in the pharmaceutical industry believe that the price of Avastin will raise concerns about whether drugs are worth it, leading to a backlash like price controls or restrictions on use.

British Agency Impugns Value Of Four Costly Cancer Drugs
By JEANNE WHALEN August 8, 2008;
Page B5 LONDON --

An agency that advises Britain's health-care system has decided that a group of cancer drugs aren't worth the money, a move that highlights a growing debate over how to balance the interests of patients with soaring drug costs. The National Institute for Health and Clinical Excellence, or NICE, said in a preliminary ruling Thursday that four drugs used to treat advanced kidney cancer -- Roche Holding AG's Avastin, Bayer AG's Nexavar, Pfizer Inc.'s Sutent and Wyeth's Torisel -- aren't effective enough to warrant their high cost and shouldn't be prescribed to new patients in Britain. If the preliminary judgment holds, Britain's National Health Service won't pay for the drugs' use in treating a type of advanced kidney cancer known as renal cell carcinoma. The drugs are prescribed for this purpose in the U.S. and elsewhere in Europe. NICE's decisions are closely watched by governments and health insurers around the globe. Expensive cancer drugs present a particular dilemma for these health-care payers as they redouble their efforts to rein in drug spending. In a statement, Pfizer said it is "disappointed" and "committed to working with NICE to overturn this preliminary guidance." Bayer also expressed disappointment, noting that Nexavar is available in more than 70 countries. Roche and Wyeth didn't immediately respond to requests for comment. NICE will give drug companies, patient groups and others a chance to comment before making a final recommendation. In its preliminary findings, NICE said the drugs extended some patients' lives, but were ultimately not effective enough to justify their expense, which ranges from £3,100 ($6,036) to £6,100 for a six-week treatment cycle. Using data from clinical trials and complex financial models, NICE estimated that the drugs cost between £71,500 and £171,300 for each year of healthy life they give patients. NICE generally thinks that Britain shouldn't pay more than £30,000 for a year of healthy life gained -- also known as a quality-adjusted life year, or QALY.