by Jeremy Laurance
29 April 2013
Rip-Off Prices for Drugs Set by
'Profiteering' Big Pharma Giants
Doctors say industry
'profiteering' threatens lives
An influential group of cancer experts has warned that the high
prices charged by pharmaceutical companies for cancer drugs are
effectively condemning patients to death.
The group of more than 100 leading cancer physicians from around the
world, including nine from the UK, accuse
the drug industry of "profiteering"
- making a profit by unethical methods such as by raising the cost
of grain after a natural disaster.
Of the 12 drugs approved by the Food and Drug Administration
in the US in 2012, 11 were priced above $100,000 (£65,000) per
patient per year. In addition the price of existing drugs of proven
effectiveness has been increased by up to threefold.
The specialists say:
"What determines a morally
justifiable ‘just price’ for a cancer drug? A reasonable drug
price should maintain healthy pharmaceutical industry profits
without being viewed as ‘profiteering’.
This term [profiteering] may apply
to the trend of high drug prices where a life threatening
medical condition is the disaster."
The high prices mean the drugs may not
be approved by the National Institute for Clinical Excellence
in the UK forcing doctors to fill in a 14 page application apply to
the Cancer Drugs fund for British patients who could benefit from
In addition, the rising cost of existing drugs in a cash limited
health service such as the NHS means treatment is denied to other
patients with other conditions.
The authors of
the article, published in
the journal Blood, are all
specialists in blood cancers such as leukemia, where cancer drugs
have proved most effective.
One of the best known - imatinib, whose brand name is
Glivec - has proved so successful
in chronic myeloid leukemia that patients who a decade ago survived
for a few years can now look forward to a near-normal life
But the cost of Glivec has risen from £18,000 per patient per year
to around £21,000 in the UK, and from $30,000 to $92,000 in the US.
This is despite the fact that all
research costs were covered by the original price, and the number of
patients treated and the length of time they are on the drug have
both vastly increased because of the drug’s success.
Daniel Vasella, former chairman and chief executive of
Novartis, the manufacturer, said the original price charged for
Glivec in 2001 was considered "high but worthwhile" and was
estimated to yield annual revenues of $900 million, enough to cover
its development cost in two years.
A decade later Its annual revenues in
2012 were $4.7 billion (£3 billion). The cancer specialists say the
revenue earned by Glivec over the last ten years "represent generous
profits to the company".
But this has put heavy pressure on those
who have to foot the bill.
"Grateful patients may have become
the financial victims of the treatment success, having to pay
the high price annually to stay alive".
In the US even those with health
insurance may pay an average of 20 per cent of drug prices out of
pocket. Drug prices are the single most frequent cause of personal
bankruptcies in the US.
Three new drugs have been approved for chronic myeloid leukemia in
the last year by the FDA but the prices are "astronomical" the
authors say at up to $138,000 a year per patient.
Worldwide only about a quarter of the patients with chronic myeloid
leukemia who could benefit have access to drugs because of the cost.
"A small fraction are rich enough to
pay individually, and most are treated intermittently or not at
all. The effects of these financial pressures on long term
survival… are yet unknown."
In the UK, patients are shielded from
the "direct economic anxieties of illness", the article says.
But Professor Jane Apperley,
chair of the Department of Hematology at Imperial College, London,
and one of the authors, said high drug prices were still a cause of
harm in Britain .
"The price of a drug heavily
influences the decision of NICE whether we can prescribe it on
the NHS. I am chief of service at Imperial College and we are
constantly being asked to reduce our spending. We have to look
very carefully at the cost of the drugs we use."
"Of course we need the pharmaceutical industry to go on
developing new drugs. It is very exciting that a number of
cancers are now becoming susceptible to these new drugs. But the
rising cost is unsustainable. "
"The drugs are very effective at keeping people alive. But if
they are priced out of what you can afford you know that you can
keep people alive but you can’t afford to do so. It is
completely unsustainable for the NHS because the costs are going
up every year.
We need a serious dialogue about
whether we can sustain these costs."
The authors of
in Blood conclude:
"We believe the unsustainable drug
prices may be causing harm to patients. Advocating for lower
drug prices is a necessity to save the lives of patients who
cannot afford them.
We believe drug prices should
reflect objective measures of benefit, but should not exceed
values that harm our patients and societies."
The group say they intend to organize
regular meetings and campaign for lower cancer drug prices.
A spokesperson for the UK charity Beating Blood Cancers said:
"As a charity we want to see an
ethical approach to drug pricing . There is no point in us
investing in research if the pricing policy means drugs won’t be
available to patients."
In a statement to The Independent,
"We recognize that sustainability of
health care systems is a complex topic and we welcome the
opportunity to be part of the dialogue. Our critical role, as
one of many parties working towards improving cancer care, is to
discover and develop innovative treatments."
"Novartis innovation in chronic myeloid leukemia (CML) has
changed the course of the disease. Before Glivec (imatinib)* and
Tasigna (nilotinib), the five-year survival in CML was only 30
percent. Today, nine out of ten patients with CML have a normal
lifespan and are leading productive lives."
"Over the years, our programs have evolved to improve patient
access to our medicines. We work together with government health
care systems, charities and other payers to build successful
Expert view -
‘Price of drugs is harming patients’
The following is an extract from an article, contributed to by more
than 100 leading cancer physicians from around the world, including
nine from the UK, published in the journal, Blood.
"This perspective reflects the views
of a large group of CML experts, who believe the current [high]
prices of drugs may compromise access of needy patients to
highly effective therapy, and are harmful to the sustainability
of our national healthcare systems...
If drug price reflects value, then it should be proportional to
the benefit to patients in objective measures, such as survival
prolongation, degree of tumor shrinkage, or improved quality of
life. For many tumors, drug prices do not reflect these
endpoints, since most anti-cancer drugs provide minor survival
benefits, if at all.
As physicians, we… believe the unsustainable drug prices in CML
and cancer may be causing harm to patients. Advocating for lower
drug prices is a necessity to save the lives of patients who
cannot afford them…
For CML, and for other cancers, we
believe drug prices should reflect objective measures of
benefit, but should also not exceed values that harm our
patients and societies."
An ethical price tag?
Brands used for the treatment of chronic myeloid leukaemia:
Imatinib (Glivec) £21,000 per
patient per year - Novartis
Designed from first principles, it proved hugely effective
and unexpectedly turned into a blockbuster, earning billions
of pounds for its makers.
Nilotinib (Tasigna) £21,000 -
Designed for patients who fail to respond to Glivec,
Novartis reduced the cost to get it past Nice, whilst
increasing the cost of Glivec.
Dasatinib (Sprycel) £31,000 -
Bristol Myers Squibb
Also designed for patients who cannot take Glivec. But it
has not been approved by Nice for use on the NHS because of
its high cost.
Bosutinib (Bosulif) £76,000 -
For patients who suffer side-effects from the other drugs.
It won approval in the US in 2012 but is awaiting a license
in the UK.
Omacetaxine (Synribo) £100,000 -
For patients who cannot tolerate other drugs. Approved in US
in 2012 but awaiting license in the UK.
Ponatinib (Iclusig) £90,000 -
A third-generation drug which works in a different way.
Approved in the US in 2012 but awaiting a license in the UK.