When I recurred last year, my doctor suggested that, instead of trying carboplatin with Lipodox, I go on a clinical trial where I was guaranteed to get Avastin, which he considered a good treatment option. ( I have written about my trials with the experimental drug in that clinical trial
here). He said that the data on Avastin for achieving remission for recurrent ovarian cancer were quite good even though the drug had a bad reputation due to some infrequent but very serious side effects. The other problem with Avastin was that insurance many times did not pay for it so a clinical trial would be a good alternative. I recently talked to Lisa Zamosky about this issue which was discussed in an excellent
LA Times article about approaches to paying for expensive medications.
I mentioned for the
article that I was told that Cedars charged $25,000 a dose of Avastin. I was getting a dose every two weeks so at that price, the cost of Avastin treatment alone would be $650,000/year. Cedars would not confirm this charge for the LA Times. This amount seems quite high compared with the amount being charged for Avastin in Britain to the NHS, which,despite the lower price tag, recently was told
twice by its cost cutting advisor (NICE) that the efficacy of Avastin in improving overall survival
did not justify its cost for
metastatic recurrent ovarian cancer.
Apparently, however, the cost of Avastin for the patient in the United States, like the cost of procedures in hospitals (a hot topic in the news today-- see
here,
here and
here) varies quite a bit from hospital to hospital. In a
nice piece of investigative journalism published on September 22, 2012 , the
Charlotte Observer and
The News & Observer of Raleigh in North Carolina found:
Large nonprofit hospitals in North Carolina are dramatically inflating prices on chemotherapy drugs at a time when they are cornering more of the market on cancer care. . .The newspapers found hospitals are routinely marking up prices on cancer drugs by two to 10 times over cost. Some markups are far higher.
In particular, these newspapers
produced a chart on Avastin showing a wide discrepancy in prices paid at different hospitals. The chart is based on data from Medicare and Medicaid, rather than the hospitals themselves. As
one hospital said, "You requested a list of drugs and what we pay vs. our cost vs. charges, but we are under contract with our suppliers to not disclose that information."
Read more here: http://www.charlotteobserver.com/2012/09/22/3549693/statement-from-novant-health.html#storylink=cpy
Why are the prices so disparate? Duke University charges close to what my hospital, also a teaching or university hospital, allegedly charges for Avastin. But NC Baptist charges about a third of the price.
One hospital explains the differences on the mix of government payments (i.e underpayments) vs. insurance payments. Another
claims that its higher prices are due to "higher volumes of uninsured patients and provid[ing] more sophisticated services, such as clinical trials."
The
hospital trade association, NC Hospital Association, blames the complexity of cancer treatment and "resource consumption" for the high prices:
Resource consumption drives cancer drug prices in hospitals. Medicines that treat cancer are toxic, dangerous chemicals that demand the highest levels of trained personnel, specialized equipment and facilities. The resources hospitals must devote toward making cancer care safe for patients and staff far exceed those required for most other medications. Adding these necessary safety elements adds to the cost of administering cancer drugs. Hospital pharmacists are very heavily involved in the delivery of cancer medicines. Pharmacists spend more time preparing cancer drugs for administration than most other medicines used in hospitals. The higher charges for cancer medications reflect the higher hospital costs.
Presumably some of these hospitals have higher demands on resource consumption than others. A
n article on disparities in charges medical procedures in the New York Times today (May 8, 2013) reported Keck Hospital of the University of Southern California's resource consumption rationale for such higher prices: " “Academic medical centers have a higher cost structure, and higher acuity patients who suffer from many health complications,” the hospital said." However, the
NY Times article disputes this explanation:
The data showing the range of hospital bills does not explain why one hospital charges significantly more for a procedure than another one. And Medicare does pay slightly higher treatment rates to certain hospitals — like teaching facilities or hospitals in areas with high labor costs.
Again, the lack of transparency of costs and charges makes it difficult to understand this disparity. Hopefully these articles on drug charges and procedure charges will raise awareness in the public to demand more transparency or to find facilities that charge less.
