In the current issue of the Mayo Clinic Proceedings, Hagop Kantarjian, MD and S. Vincent Rajkumar, MD discuss the high cost of cancer drugs and propose some solutions. The high cost of cancer drugs is widely known. Unfortunately, this new article does not provide solutions that have an immediate chance of implementation and/or success.

For example, the authors propose government action to allow Medicare to negotiate on drug prices, which is unlikely to occur in the current political environment.

What is needed instead, I believe, is a discussion involving all the stakeholders— pharmaceutical companies and insurance carriers, but also health economists and policy advisors to mediate and guide the discussions. In this setting, realistic solutions can hopefully emerge which transcend finger-pointing. We need specific action items and, since each cancer is different, we need recommendations tailored to the myeloma community. This requires input from both myeloma doctors and patients.

Focus on best outcomes

What constructive suggestions can be made by the myeloma community? First, I would argue, there must be a focus on the best outcomes. It is helpful that we now have a focus on earlier diagnosis, which leads to more decisive treatment choices to achieve the maximum response. For example, triple therapy to achieve VGPR or ≥ CR or even MRD negative status is highly feasible. An optimal treatment package, a pathway or guideline, can be developed incorporating induction, ASCT if appropriate and consolidation and/or maintenance.  We can lower the cost of myeloma treatment by creating a competitive environment in which physicians see best outcomes, patients can opt for a tolerable and effective approach, and regulators can see a manageable cost structure with clear value.

A drug holiday?

An increasing subset of patients can achieve CR or better and avoid indefinite treatment. We already know that good risk patients achieving excellent responses can be safely followed off therapy. The result?  A treatment-free interval – a drug holiday – a sought-after goal for many patients, which is also attractive to regulators who manage total costs. For now, many patients need and benefit from ongoing therapy. For those patients, a price structure is needed that does not confer a huge burden on the individual or the healthcare system. This is where creative solutions are required.

Another question that must be raised in any discussion of cancer drug costs is: What do we do about drugs that offer only limited increases in survival at significant costs and toxicities? There must be a way to prioritize the search for new drugs that really make a difference – those that achieve improvement in survival of years, not months. It is to everyone’s advantage to improve both outcomes and value. Such drugs should receive a competitive edge.

Clearly, costs cannot continue to skyrocket. Good health is not a commodity like a widescreen TV. A widescreen TV can sometimes fit in the family budget. But, healthcare costs must fit within both the family and total healthcare budgets. Yes, profits to recoup drug discovery and development are fair. But there has to be a limit that stops short of bankrupting the whole healthcare system.

How to achieve this in an equitable fashion is the challenge – but a challenge which we can no longer ignore. All parties must work together to come up with solutions which work and can be implemented.

If you have ideas about what can work, let us know. At the IMWG Summit in June, a working group will debate the topic. But there must also be many great ideas out there which can help chart a way forward. So let the dialogue begin!

Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

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