Drug Costing $9,200 Scores Zero on Cancer Doctor Value Scale

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The leading group of U.S. cancer doctors created a scoring system for oncology drugs, awarding a zero for overall benefit to the $9,200-a-month regimen featuring Eli Lilly & Co.’s Alimta.

The formula ranges from 0 to 100 points and was published Monday in the Journal of Clinical Oncology. It aims to simplify the complex statistics behind cancer medicines into a single “net health benefit” score that weighs a drug’s ability to extend life or delay progression against potential toxic side effects.

The ultimate goal is to assess many drugs and put the data into a user-friendly mobile software application that patients and doctors can use at the bedside, said Richard Schilsky, chief medical officer for the American Society of Clinical Oncology, which convened a task force to assess value.

The scoring system combines efficacy and toxicity data into a single number, with the most weight given for how much a drug extends survival or delays disease progression. Points are subtracted or added if a new drug regimen is more or less toxic than the previous standard it was tested against. Drugs for advanced cancer can get bonus points if they reduce symptoms or lead to treatment-free periods, giving those medications a potential maximum score of 130.

Top Seller

Lilly’s Alimta, which scored a zero as part of a regimen for advanced lung cancer, was the company’s top-selling drug in 2014 with $2.79 billion in revenue. Analysts expect Alimta will continue to generate sales of more than $2 billion through 2021, according to data compiled by Bloomberg. Lilly spokeswoman Carla Cox said the company was still reviewing the system and said the assessment doesn’t represent the intended patient population of people with nonsquamous non-small cell lung cancer.

“What I can say is that tools that make generalizations about the value of cancer medicines in the interest of cutting costs dismiss the continuous and complex nature of cancer innovation and could threaten future progress and patient access to better treatments,” she said.

Herceptin Leads

So far, the oncology group has only scored a handful of drug cocktails for advanced lung cancer, advanced prostate cancer, multiple myeloma and early-stage breast cancer. The highest score so far is 48 of 100 for an early-stage breast cancer regimen including Herceptin from Roche Holding AG.

Some expensive drug regimens for advanced cancer get low scores.

A lung cancer regimen including Roche’s Avastin gets a mere 16 points out of a possible 130 score for overall health benefits, due to its small survival benefit. The treatment costs more than $11,900 per month, according to the study.

Susan Willson, a spokeswoman for Roche’s Genentech division, said the company had not yet had the chance to review the details of the ratings.

“We support efforts to better understand how treatments affect patients,” she said. “Medicines like Avastin, Herceptin and Tarceva have helped people live with cancers that were once a death sentence.”

Herceptin, for example, has helped more than 90 percent of people with one type of breast cancer live at least five years, she said.

In prostate cancer, a cocktail including Sanofi’s Jevtana received a 16 of 130 possible points, with a cost of about $10,700 per month. Greg Miley, a Sanofi spokesman, said he had no immediate comment.

Scores of the drugs cannot be directly compared because the system only evaluates a regimen relative to the older drugs it was tested against in its clinical trial, not its current competitors.

Task Force

Also, a single drug can have multiple different scores, depending on which type or stage of cancer it is used in and the drugs it is combined with.

“This is not a way of ranking drugs,” said Lowell Schnipper, chair of ASCO’s value in cancer care task force, on a conference call with reporters. Schnipper is also chief of hematology and oncology for the Beth Israel Deaconess Medical Center in Boston.

Rather, the system is a “vehicle or mechanism to help guide decisions between doctors and patients” as they evaluate different treatment options, Schilsky said in an interview.

Drug Costs

Contrary to expectations, the task force, which also included representatives from the drug and insurance industries, didn’t include cost directly in the system. They decided that a single formula combining cost, efficacy and side effects would be too complicated for patients to understand, Schilsky said. Instead, the cost of a drug regimen will be displayed as a separate line next to the net health benefit rating.

The task force didn’t feel it had good enough data for all the possible direct and indirect costs associated with a cancer treatment to include the cost information in a single score, Schnipper said.

ASCO is now soliciting comments on the proposed system. The task force has been working on the rating system for more than a year.

“Value and cost are among the biggest issues in health care today, but there are few tools to help doctors and patients objectively assess benefits, side effects and costs,” Julie Vose, president of ASCO, said in a statement.

The scale could influence how drug makers test medications in the future. Drugs that clearly reduce cancer symptoms, in addition to lengthening life, can get bonus points, which may encourage drug makers to test whether their drugs improve quality of life.

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