Debating Value Versus Cost for Immunotherapy

Meir Rinde
Published: Wednesday, May 16, 2018
Joseph Alvarnas, MD

Joseph Alvarnas, MD
The high costs of cancer drugs have drawn criticism and scrutiny for a number of years, but sticker shock reached a new level recently over the price tags attached to the first of what are expected to be a growing number of chimeric antigen receptor (CAR) T-cell therapies. Up-front prices are approaching 0,000 for a 1-time treatment.

Drug prices “often do not reflect the benefits experienced by patients. Steps must be taken to better align drug prices and costs with their value. Achieving better alignment could improve the quality of cancer care; create incentives for development of innovative, effective new drugs; and help address increases in drug spending that are threatening to put high-value drugs out of reach for some patients,” the report said. “Developing and implementing a widely accepted value framework for cancer drugs is a critical step toward value-based pricing.”

Studies Analyze CAR T-Cell Therapies

Since a key component of any value equation is the effectiveness of the treatment being evaluated, the 2 FDA-approved CAR T-cell therapies have fared well in early analyses despite their high price tags.

Figure 1. Key Component sin Pricing Equation1

Last August, the FDA granted the first approval for tisagenlecleucel (Kymriah) for treating patients up to age 25 years with B-cell precursor acute lymphoblastic leukemia (B-ALL) that is refractory or in a second or later relapse. Novartis announced a 5,000 price tag; with hospital markup, preparatory chemotherapy, management of adverse events and other factors, the total cost of treatment could reach .5 million per patient.2 The company established an outcome-based payment arrangement for Medicare and Medicaid patients, under which CMS won’t pay for patients who do not respond in the first month of treatment. In January, the FDA additionally granted a priority review for tisagenlecleucel for adults with relapsed/refractory diffuse large B-cell lymphoma who are ineligible for or who have relapsed after autologous stem cell transplant (SCT).
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