Leukemia: High Treatment Costs Harming Patients

Photo: Blood clots

Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells; © panthermedia.net/
Sebastian Kaulitzki

The increasing cost of treatments for chronic myeloid leukemia (CML) in the United States has reached unsustainably high levels and may be leaving many patients under- or untreated because they cannot afford care, according to a study.

CML was selected as the focus of the piece because it is now considered a highly curable disease, thanks to the emergence of powerful, targeted CML therapies known as tyrosine kinase inhibitors (TKIs) that allow patients to manage their disease with few symptoms by taking a well-tolerated pill. Since the introduction of TKI therapy more than a decade ago, the annual mortality of patients with this disease has declined from 10 to 20 percent in the early 2000s to just 2 percent today and the estimated 10-year survival of CML patients has increased from 20 percent to more than 80 percent. Patients with CML, who were once told at diagnosis that they had a grim prognosis, are now enjoying close to normal life spans as long as they receive and adhere to prescribed treatments. The management of CML has become similar to that of chronic disorders such as diabetes and hypertension, yet a key difference remains in the extremely high cost of CML drugs.

"Patients with CML have a much better outlook today than ever before, thanks to advances that have greatly improved survival rates. But these patients now face dire financial struggles as they try to maintain their treatment regimen with the drastically inflating cost of care. And this issue likely extends to patients with other types of cancer who require ongoing treatment to maintain therapeutic benefit," said corresponding study author Doctor Hagop Kantarjian of The University of Texas MD Anderson Cancer Center.

Kantarjian and colleagues say that newly approved CML treatments in the U.S. are priced substantially higher than older options, and the trend is consistent among other cancer types. For example, of the 12 drugs approved by the U.S. Food and Drug Administration for various cancer indications in 2012, 11 were priced above 100,000 dollars per year. Monthly cancer drug prices today (more than 10,000 dollars per month on average) have almost doubled from just a decade ago, when they averaged 5,000 dollars per month. The overall cost burden on families is significant, as out-of-pocket cancer care-related costs comprise approximately 25-30 percent of an average annual household budget. Cancer care-related costs contribute heavily to the unprecedented cost of health care in the U.S., now estimated at 18 percent of the U.S. Gross Domestic Product, compared with just 6-9 percent in much of Europe.

"A major question we need to answer is how to determine the 'right' price for these drugs. In many cases, it makes sense to let the market govern the price; however, when a product is directly related to a patient's survival over a period of years, it is critical to set a price that allows companies to profit and ensures that patients can afford their treatment," said Kantarjian. "Since CML treatments must be taken on an ongoing basis, we are concerned that the surging prices are potentially harming patients."

MEDICA.de; Source: American Society of Hematology