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Dr West

Frogs in boiling water: On breaking the $10,000 barrier

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Note: Novartis has provided funding to GRACE for our recent ALK-positive patient forum.

Last week, the FDA approved Zykadia (ceritinib), the second generation ALK inhibitor.  As I wrote in my post about this new agent its rapid approval as the first effective treatment for acquired resistance to a targeted therapy in advanced lung cancer, there should be little question that it provides a helpful new option.  A couple of days later, I learned the cost: $13,500/month.

I felt some sticker shock over this. After initially being shocked at the price of EGFR inhibitors at around $5000/month, then having then escalate every few years, we saw the approval of XALKORI (crizotinib), setting a new pace in lung cancer, at $9800/month. Though that represents a heady range, we cou;d also potentially justify the cost by saying this was a very limited population and that criotinib provided a profound benefit. 

I was shocked about the cost of Zykadia, at $13,500, which made the $9800/month cost of XALKORI seem quaint, like a relative bargain. I expressed my concerns to the folks at Novartis, saying that I thought the price was aggressive and approaching extortionate, especially after the FDA approved the drug just a couple of years after it began phase II testing, based on just 140 patients, not the typical requirement of large, expensive phase III trials over many years that provided the justification for the high cost of these drugs in the past.

To their credit, they were very responsive and got back to me about my concerns.  They made several points that made me feel as though the question of cost and value for cancer agents is a fair concern, but also that their pricing was a thoutful process, what they estimated as fair market value relative to other agents and not just a simple opportunity to demand the absolute most that could be obtained.

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