The following is a guest post submitted by Harold DeMonaco, director of the Innovation Support Center at the Massachusetts General Hospital and one of our most active expert story reviewers on HealthNewsReview.org.
Last week’s New England Journal of Medicine had two rather provocative and thought provoking perspectives.
The first relates to a decision by the Center for Medicare & Medicaid Services to re-evaluate its decision to reimburse for Provenge. It was entitled, “Listening to Provenge — What a Costly Cancer Treatment Says about Future Medicare Policy.” Provenge has the distinction of being the most expensive approach to the treatment of any cancer. It was approved by the Food and Drug Administration for the treatment of advanced prostate cancer and demonstrated a median improvement in survival of 4.1 months in clinical trials. The treatment costs are approximately $100,000.
Why is this important and why should journalists have picked up on this article in the NEJM? There were about 190,000 men diagnosed with prostate cancer in the United States in 2009. Twenty to forty percent of them will receive androgen deprivation treatment. That’s between 38,000 and 76,000 men annually who would presumably be eligible for treatment. The bill for those 4.1 months is $7.6 billion. Medicare spent about $500 billion in 2010. This one drug will add about 1.5% to that expenditure.
Given the debate about the future of Medicare and the proposals to replace it with a voucher system, one would have assumed that this would have been newsworthy. This is exactly where the debate of the future of Medicare should be focusing. Can we afford to continue to pay for treatments that provide what many would call a marginal benefit? Can we afford not to? Although the increase in survival was only 4 months (from 21 months to 25 months), some men survived longer. Of course some did not. The final decision on Provenge will be interesting and will likely provoke a maelstrom of complaints regardless of the outcome.
The second article relates to the recent approval of Makena. It was entitled, “Unintended Consequences — The Cost of Preventing Preterm Births after FDA Approval of a Branded Version of 17OHP.” Makena is a version of an existing synthetic progestin that has been used since a 2003 study demonstrated its value in preventing premature labor. 17OHP (the abbreviated version of the drug name) has been available from compounding pharmacies with a 20 week course costing about $300. Earlier studies demonstrated the Number Needed to Treat is 14 so the cost of preventing a premature birth is $4,200. The direct cost associated with a premature birth is $33,200. That was until the FDA approval. K-V Pharmaceuticals has priced Makena at $29,000 to the pharmacy for the same 20 week treatment. Based on this pricing, the direct costs for preventing a premature birth is $406,000.
These drugs represent significant health policy issues. Both deserve considerable thought and assessment prior to any judgment on the part of the public. So, while there has been some news coverage of these drugs, journalism could provide a better public service by dropping back to address the bigger picture for news consumers and health care consumers. Connect the dots on the Provenges, the Makenas, the robotic surgery systems and proton beam facilities – more often, more emphatically, more broadly – to help citizens understand why we lead the world in percentage of the GDP devoted to health care spending without a concomitant world-leading rank in health care quality and outcomes.
By Harold DeMonaco