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Expensive cancer treatments can add years - and big debts

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http://www.philly.com/mld/inquirer/news ... 413354.htm

Pricey, yet effective, medicines present patients with a distressing choice.

By Dunstan Prial


Many cancer patients are facing what amounts to a life-or-death decision, one whose ramifications could impact their families long after the battle against their disease is over.

In recent years, new cancer treatments have emerged that have proved capable of extending the lives of very ill patients for up to two years. That could mean the difference between attending a child's graduation or wedding or seeing the birth of a grandchild.

These treatments are becoming so expensive, however, that experts say some patients are being forced to decide between taking the drugs and potentially exposing themselves and their loved ones to a mountain of debt, or rejecting the treatments altogether.

"It's very distressing to the patients," said Cheryl Hodges, office manager for a team of oncology doctors affiliated with Englewood Hospital and Medical Center in Englewood, N.J. "They're dealing with their illness, which is obviously very difficult, but also with the financial impact, which can be completely overwhelming."

Consider Avastin, hailed as a miracle drug when it was approved two years ago because it doubled the life expectancy of advanced colorectal cancer patients to about 20 months.

But a shudder ran through the American health-care system this year when Avastin's maker said the drug is being tested as a treatment for breast and lung cancer at a projected cost to patients and health insurers of about $100,000 a year.

The fear is that if many thousands of Americans with breast and lung cancer choose Avastin treatments, the billions of dollars in costs will further strain a fragile health-care system.

And Avastin is hardly unique.

Bristol-Myers Squibb's colorectal cancer drug Erbitux, which was recently approved for treating head and neck cancer, runs $2,400 for each weekly dose. A full course of therapy, which runs from seven to 11 weeks, costs from $16,800 to $26,400.

Treatments can go on for a couple of years.

As advances in research have created new opportunities for treating various forms of cancer, the potentially broad - and lucrative - market for these treatments has prompted drug companies large and small to target oncology.

Indeed, worldwide sales for cancer treatments are expected to double to $55 billion by 2009, according to IMS Health, which tracks pharmaceutical sales.

Health-care professionals note that Medicare, the government's health insurance program for the elderly, is generous in its coverage for cancer patients. The drug companies also help out with co-payments or prescription replacements through so-called patient assistance programs. And many health plans cover as much as 80 percent of a patient's costs.

But that still leaves the patient responsible for the other 20 percent. And as treatment costs soar, that 20 percent is growing more burdensome.

Defenders of the escalating costs argue that it's difficult to put a price tag on a drug that can save lives.

Madeline Malia, a Bristol-Myers spokeswoman, noted that Erbitux is the first head and neck cancer treatment to be approved in decades, and that it can extend the lives of patients for up to two years.

Still, some experts believe a day of reckoning is imminent.

Employers and health insurance companies are eventually going to "choke" on the escalating costs, said Deborah Schrag, an associate professor at Memorial-Sloane Kettering Cancer Center in New York.

According to Schrag, most patients are choosing the new treatments despite the high costs. This often forces physicians to act as de facto financial advisers, she said, placing them in the unfamiliar and awkward position of explaining costs and possible methods of payment.

Avastin was developed and is marketed through a partnership between Genentech and Roche.

Roche executives are eager to explain why cancer drugs are so expensive.

On average, it costs about $900 million and takes nearly a decade to develop any new drug, said Kapil Dhingra, Roche's vice president for medical science-oncology.

Finding effective new cancer treatments is especially difficult, said Dhingra, who noted that nine out of 10 experimental cancer drugs that enter the Phase I testing stage never make it to market.

"Our business is unique in that if there's one commonality across our industry, it's the high rate of failure," Dhingra said.

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