The problem with medical progress
There has been an alarming upward trend in the costs of similar treatments, as more drugs are developed and come on to the market, new Pharmac figures show.
I would argue that this is almost precisely not the problem. The story covers two important issues, but doesn’t distinguish them well.
The first issue is that many expensive new drugs aren’t very good. To get a drug approved for marketing you don’t need to show it’s better than the current stuff, and it often isn’t. Similar treatments might still be useful to have, if they give other options for people with side effects or have more convenient dosing, but they are often more expensive.
The United States is very bad at not using treatments that are similar (or worse) but more expensive, so these drugs are a problem there. Here, we’re quite good at not using them, so they don’t matter all that much. As long as Pharmac enjoys popular support and the media doesn’t buy into too many drug-industry publicity campaigns, we can ignore the expensive new drugs that aren’t worth the cost.
A second issue is that a subset of the expensive new drugs aren’t similar. The story quotes the price differences for ‘anthracycline’ (doxorubicin or epirubicin) and two newer breast cancer drugs, docetaxel and trastuzumab, as evidence of increases over the years.
Anthracyclines haven’t gone away. In fact, they’re quite a bit less expensive now than they were in 2002. The reason Pharmac now buys docetaxel and trastuzumab is that they’re worth the extra cost for at least some women. The existence of trastuzumab is not a problem for the healthcare system, it’s an opportunity.
There is a problem coming, though: many of the new drugs have names ending in ‘mab’.
Monoclonal antibodies, ‘mab’s, are one of the classes of ‘biologics’: big, complex molecules made by living cells. Making and testing generic versions of biologics (called ‘biosimilars‘) is much harder than running up off-brand doxorubicin. Even when the patents run out on the ‘mab’s and ‘ept’s, a competitive market might be a while in developing and prices will stay higher. It’s not so much the expensive on-patent drugs that are a worrying change, it’s the prospect of expensive off-patent drugs in the future.
Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »