A big breakthrough that brings hope to breast cancer patients! A recent study has found that adding a ribociclib, a drug, to hormone therapy has significantly increased the overall survival in relatively younger women with advanced breast cancer, an IE report quoting study by researchers at the University of Texas MD Anderson Cancer Center said.
The findings of the above mentioned study has already been termed as one of the greatest advances in breast cancer treatment in recent decades.
Notably, after 42 months, seventy percent of the patients who had undergone treatment had survived as compared with forty six percent of those patients who had received hormone therapy alone.
For those who are not yet convinced about the seriousness of these details, take a look at some of the facts pertaining to breast cancer, which is the most frequent cancer among women, according to the World Health Organization as it impacts 2.1 million women every year.
This also causes the highest number of cancer-related deaths – fifteen per cent to be exact 0 among women — 6,27,000 or 15% in 2018. In fact, breast cancer accounts for 14% of all cancers in Indian women.
For instance, at AIIMS, almost 35% of patients with HR+ breast cancer and HER2-negative disease are aged below 40! The standard treatment includes hormonal treatments.
Surgery is mostly the treatment method for women diagnosed with breast cancer in stages one, two or three, followed up by radiation therapy. For some women, drug therapy may also be recommended, post-surgery.
According to the IE report, it may be that some private hospitals may already be using this drug. However, this drug is not available at any of the government hospitals.
For key stakeholders such as patients and hospitals, the biggest concern is that treatment is very costly as the drug costs around Rs 50,000 to Rs 60,000 per month, with the duration differing on a patient-to-patient basis.
Several doctors recommend that this drug has a clear edge over conventional cancer treatment options such as chemotherapy.
The downside is that while the drug boosts the chances of surviving for a longer span, the cost is not easy for the common man to go forward with.
The Lancet Oncology Commission on Global Cancer Surgery called for a ‘radical shift in cancer policy’ in 2011, emphasising on ‘delivery of fair prices’.
In 2013, a group of more than 100 cancer experts pointed out a disturbing statistic – 11 out of 12 medicines approved by the US FDA in 2012 for various cancer indications were priced above $100,000 per year!
In December 2018, the WHO’s report ‘Pricing of Cancer Medicines and its Impact’ raised some concerns that still remain relevant despite the big breakthrough.
Some of the key questions that the WHO report in 2018 attempted to highlight are:
1. What are the objectives of an optimal pricing policy with consideration in the context of cancer medicines?
2. What approaches are used for pricing cancer medicines?
3. What are the impacts of these pricing approaches on the affordability and availability of cancer medicines?
4. What are the potential unintended consequences of pricing policies?
5. What are the potential options that might enhance the affordability and accessibility of cancer medicines?
While the report is comprehensive in its coverage of the pricing of cancer medicines, a disturbing concern has been highlighted with a specific reference to India.
Refer to page 98 of the report, which states as follows:
“In the absence of insurance coverage, cancer treatments would be unaffordable to a large proportion of patients. For example, a course of standard treatment for early stage HER2 positive breast cancer would cost about ten years of average annual wages in India and South Africa and 1.7 years in the USA.”
It further adds, “Costs associated with other interventions (surgical interventions and radiotherapy) and supportive care (anti-emetics and haematopoietic growth related factors) would worsen the unaffordability of overall care. Even with insurance coverage, patients in many countries have reported experiencing financial stress to the extent that they would lower the treatment dose, partially fill a prescription or even forego treatment altogether to mitigate the costs.”
A pressing argument to defend the high prices of cancer medicines is that there is an urgent need to reward innovations to incentivise R&D of future medicines.
This argument falls weak on account of multiple variable. For instance, it is increasingly evident that there is seemingly disproportionate levels of research for cancer medicines.
Another aspect to consider is that the inefficiency of R&D for cancer medicines not only pertains to duplication but also a counter productive ethos of pursuing marginal indications.