Here we address questions regarding the affordability of RIT ...
Emphasizing that our efforts on behalf of RIT are done for one purpose: to ensure that patients have access to this effective class of drugs, and that research is not crippled by short-sighted policy decisions, no matter how well-intentioned.
We underscore that Patients Against Lymphoma is a patient-centered non-profit group, which is independent of health industry funding. That is, we have no financial conflict of interest in this matter.
Q: Are the sponsors charging too much for Bexxar and Zevalin?
It's worth noting that for RIT there are two approved agents (Bexxar and Zevalin) and therefore, atypically, price competition is already in effect for these new agents - and for Bexxar when it was first approved
Furthermore, the price of Zevalin (as best we can tell) did not edge downward when Bexxar also won marketing approval.
We think these facts are very good indications that manufacturing and development costs are the primary reasons these biological agents cost so much to provide ... and that it is not a result of greed.
Finally, CMS policy of cutting reimbursements so far is exclusive to radioimmunotherapy - a treatment for lymphoma. Other similarly expensive targeted biological therapies have not been treated the same.
CMS discriminates against this "organ," but not others, based on misinformation. The supply is cut despite warnings of ASCO, ASH, the sponsor, and many nonprofit groups that CMS has made an error: has grossly underestimated the costs. http://lymphomation.org/wordpress/?p=14 .
Q: Can society afford to pay for expensive therapies for cancers?
We think you have to compare the one-time cost of an effective agent against the costs of repeated use less effective therapies - financial and to the patient.
Regarding the costs of RIT, it should be noted that it is probably less expensive than Rituxan-based chemotherapy, which is given repeatedly in six or eight infusions; and certainly it is less expensive (and less dangerous) than stem cell transplantation:
Notably, the alternative to RIT will many times be death, or rescue via more toxic, less effective or higher-risk therapy and more expensive in-patient treatments, such as stem cell transplantation, which is contraindicated in older patients the population most dependent on Medicare. http://lymphomation.org/CMS-RIT.pdf
From our perspective the price of a car (approximately 32K) is not too much to pay for getting your life back. And with your life back you can earn and pay taxes (give back to society, instead being a burden to society and your dependents).
To make good decisions we must consider all the information, not just a few parts of it. CMS (Centers for Medicaid and Medicare) has failed miserably on this account with its decision to cut reimbursements to hospitals in half for radioimmunotherapies (bexxar and zevalin).
They have not tallied the significant benefits of RIT in their equations: Allowing patients with disease resistant to chemotherapy a good chance to be productive members of society; allowing parents to live longer and better so they can nurture and provide for their families. These are among the many invaluable and incalculable returns on investments the reason our society rewards development of innovative health products.
http://lymphomation.org/wordpress/?p=14
Radioimmunotherapy, combines the potency of radiotherapy with immunotherapy in a targeted way, thus offering an effective platform to build on:
* as first primary therapy (already producing durable remission that suggests
cure)
* as therapy to achieve responses in patients refractory to chemotherapy (already demonstrated)
* as therapy to achieve complete remissions in patients with transformed indolent lymphoma (already demonstrated)
* as consolidation to first primary chemotherapy - already showing improvements in CR rates and durations of remission in controlled trials (current randomized clinical trial recruiting patients)
* as therapy to be followed by patient-specific vaccines, or other immunotherapies.
* as conditioning prior to autologous stem cell transplants (already showing promise and improved safety of Total Body Irradiation (TBI)
* as therapy to be combined with adoptive immunotherapy (infusions of NK cells or immune modulating agents to build on the vaccine-like effect?
* as an effective option for patients who relapse following stem cell transplant (a significant need)
Q: Why are biological therapies more expensive?
We are developing this section.
For now, see Monoclonal antibodies for a concise overview of how they are made - http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/M/Monoclonals.html
Q: Why is it important to everyone that companies make a profit on the therapies they invent and bring to market?
It is estimated that it costs approximately one billion dollars to develop and test a new cancer therapies, and that the failure rate is exceedingly high.
Because of the benefits we receive from effectively treating disease (touched on above) our society has wisely chosen to provide an incentive system to ensure that
Thus policy that undermines the ability of companies to profit from developing new cancer therapies must be challenged and overturned ...
... particularly now, that we are beginning to see genuine returns on our investments: patients living longer, more productively, and better with lymphomas and other cancers.
Further Reading:
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Practical and clinical benefits of radioimmunotherapy lead to advantages in cost-effectiveness
in the treatment of patients with non-Hodgkin's lymphoma. EDITORIAL - PDF
Nuclear Medicine Communications. 27(10):753-756, October 2006. Otte, Andreas a; Thompson, Sally L. b
"cost per year in remission (h14 862 vs. h16 967) and in particular cost per disease-free year
(h22 235 vs. h80 077) were clearly in favour of Zevalin" over Rituxan monotherapy.
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Cost-effectiveness of tositumomab and iodine I-131 tositumomab (Bexxar therapeutic regimen
(BTR)), in treatment of non- Hodgkin lymphoma (NHL). ASCO 2007
Conclusion: Overall, a BTR strategy has a favorable cost-effectiveness profile to alternative strategies including rituximab maintenance (RXM) in first, second, and third line NHL therapy. Results imply both a possible survival gain with early BTR use, and the cost-effectiveness of BTR. This modeling approach can aid in clinical decision making regarding the sequence and timing of therapy for patients with follicular NHL.
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Cost of 90Y-Ibritumomab Tiuxetan Radioimmunotherapy Versus Cost of Standard Regimens
for the Treatment of Relapsed or Refractory Indolent Non-Hodgkin
s Lymphoma
in Switzerland. Session Type: Poster Session, Board #539-III - ASH http://www.abstracts2view.com/hem07/view.php?nu=HEM07L1_1788&terms
In conclusion, 90Y-ibritumomab tiuxetan is not more expensive than other established
treatments for relapsed or refractory indolent NHL. Table 1. Per-patient costs by treatment in Switzerland.
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Monoclonal antibodies - Overview of how they are made - http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/M/Monoclonals.html
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