After reading this article from the Pittsburgh Tribune-Review on Dendreon's $93,000 therapeutic vaccine Provenge (sipuleucel-T) for advanced, metastatic castration-resistent prostate cancer, I've reached the conclusion that I'm in the minority on this one—I don't think Medicare should pay for it.
The article opens with the voice of a 62 year old man with metastatic prostate cancer, who says, "You always look for something new, whether it's good or not."
What he means is that, standard first and second-line therapies having failed, you are in the market for anything. You are, in short, desperate; so desperate that you are willing to disregard a variety of other issues that may have merit.
He continues, "I looked [Provenge] up on the internet and figured this medicine could be what I need."
No comment.
Then we hear from Skip Lockwood, CEO of a reputable advocacy group, Zero: The Project to End Prostate Cancer. He says:
"This is a very scary type of discussion that's being had, and I can guarantee you that if Provenge was a $1,000 drug instead of $100,000, this discussion would not be happening whatsoever."
Gee, you think?
He continues, "We're going to withhold a drug that could let someone see the marriage of their daughter or their son, or meet their grandchild? It is so totally frustrating."
Maybe it is frustrating, but I think it's very reasonable to withhold a drug like Provenge. To whit:
- Each treatment has been estimated to cost $93,000.
- It doesn't work in every patient.
- In those where it does work, it has at best been shown to extend life by four months.
The potential number of patients in the US who are eligible for Provenge likely numbers in the low tens of thousands. Assuming there are 20,000 and assuming Medicare pays for all of them, we're talking about a bill of $1.86 billion. That's in just one year.
That would make Provenge an instant pharmaceutical blockbuster.
And here's what's frustrating: No one is willing to say that while the patient mentioned at the beginning of this article is 62, many more of them are significantly older. Does it really make sense to pay for a marginally effective drug so that a select few patients in their 80s can, maybe, live an extra four months?
Does it really make sense to reward Dendreon's insistence to put Provenge on the market when they knew it would only be this effective? Dendreon should have spent more time in clinical trials, they should have spent more money making this vaccine more effective.
Instead they're going to become filthy rich off a drug that offers no cure, no true remission. Approximately one out of every ten Medicare dollars is spent in the last months of the patient's life. Don't think Dendreon wasn't aware of this massive cash cow. Medicare approval will only encourage other biotech companies to pursue cancer treatments with marginal efficacy.
Make no mistake, Dendreon, by way of Provenge, is the modern day version of the Merchant of Death.
By Ross Bonander
