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Innovation

PROVENGE tests the concept of comparative effectiveness

If you're unwilling to even consider the cost of Provenge you're not serious about holding the line on health care costs, because stories like this happen nearly every day.
Written by Dana Blankenhorn, Inactive on

If a cancer drug can prolong some poor man's life by 4 months, should 93,000 of your tax dollars be spent on it? How about 93,000 of your insurance dollars?

That's what Dendreon's PROVENGE does, and that's what it costs.

A letter from the 28,000-member American Society of Clinical Oncologists says yes, the drug has been approved for marketing, it works, and anyone who prescribes it should have that prescription paid for.

Medicare decided at the end of June to look closely at whether it should do this, given the price. The drug's supporters immediately charged members of the panel making the decision of a conflict of interest. (The ad is from Caretolive, which advocates on behalf of Provenge. They note that PROVENGE costs no more than many chemotherapy treatments.)

How do you feel about it? It's your money. Whether we're talking tax money or insurance money, it's your money if it comes from a common pool you pay into. If just 1,000 men get the extra four months of life from this drug, are you happy to pay $93 million for that benefit? If 100,000 get those four months, that's $9.3 billion.

There are two ways to look at this. Dendreon invested heavily in PROVENGE, and denial of PROVENGE claims would have a chilling effect on medical discovery. Writing in Forbes, equity analyst Avik Roy tells patients not to worry, that insurers cover it now, and that Medicare lacks legal authority to say no.

But this is where the rubber meets the road on all efforts to control health care costs. This is the essential difference between the American health system and that of Europe, where cost-effectiveness is routinely considered before medicine is approved for use. That's why so much of health innovation is done here. We pay for it.

We pay for it even though there may be other avenues. Researchers at Columbia say they have a 33-ingredient compound ready for human testing that could cure or even prevent the disease, and at very low dosages. Jun Yan and Aaron Katz call their compound ProstaCaid.

Or consider what Owen Witte's team at UCLA has just found, a cell-of-origin for the disease that could point to new approaches in both diagnosis and treatment. Basal cells, not luminal cells, are behind the disease, Witte found. Witte's work on leukemia previously led to the development of Gleevec, a potent treatment.

I know what my life is worth, and if I were facing imminent death then $23,000 per month might be a small price to pay. With my money. But with yours? Should we wait for more cost-effective treatments to emerge, as they are emerging before we open the public purse to PROVENGE?

And if we're willing to make this calculation for prostate cancer, what about other diseases?

If you're unwilling to consider this, many feel, you're not serious about holding the line on health care costs, because stories like this happen nearly every day. Like I said, it's the difference between the American and European systems. We subsidize their cures until the costs become acceptable to them.

Fair or unfair?

This post was originally published on Smartplanet.com

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