From Reuters: Cancer cost “becoming unsustainable” in rich nations
Factor: People living longer means that cancer has longer time to incubate and grow, it also means that mutations have many more chances to occur.
This means no matter how cost-effective we are able to make cancer treatments by way of introducing alternatives and competitive and preventive care, we may be selecting for more aggressive forms of cancers (the ones that evade preventive care and early detection, or the ones that are refractory to available therapies).
Our current treatments may also be altering cells and causing secondary cancers to form. What used to be an exception — a particular form of aggressive cancer that kills very quickly for example — may become a rule because our medical advances have managed the manageable forms of cancer, leaving the aggressive forms to manifest within the population.
We are creating selective pressure for cancer cells, and survival of the fittest cancer cells will have evolved beyond our current treatment protocols. This means we still play “catch-up” when researching for new ways that a cancer has evolved to evade our current treatments.
Thus: Consistently coming up with next generation treatments (I’m not talking about me-too drugs in same class) costs money, and as more in population may require these, costs can become unsustainable.
Over the last 10 years we’ve seen the advent of novel therapies in the cancer market: when I worked in the pharma industry, most of my peers want to work in oncology because this was a field where the pipelines are better populated than other disease states, where innovation looks “more likely” and promising compared to other fields of research.
So yes, we have alternatives in the cancer market. Then why are we still seeing statements like this from the Reuters article:
The Lancet report pointed to Dendreon’s Provenge prostate cancer treatment — which costs more than $100,000 for a three-dose course and was found in trials to improve survival by several months in patients with few other options.
I don’t have pricing data to compare the cost of prostate cancer treatment from 50 years ago versus today, but I constantly hear the high cost of cancer treatment today, instead of how prices have dropped. This high cost seems even higher for today’s “targeted” therapies including antibody-based drugs, which can be difficult to mass-produce.
I’m sure that 50 years ago, we have less options for cancer treatment than we have today — then why aren’t we hearing about the drop in prices due to more alternatives, even by comparing to what treatment options we have 50 years ago?
Factor: The cost of clinical trials — the process by which all competitors in the cancer market must undergo — have increased.
If you look at the mindset of many life science start-ups, they aren’t all looking to become vertically integrated pharma companies, at least, not anymore. It costs too much to run the clinical trials.
Most of these start-ups are hoping to get to a point in their clinical trials where it’s early enough so they don’t have to pay the entire clinical development bill, but late enough where a big pharma company with deeper pockets is willing to come and buy out the start-up without assuming too much risk. [Witness the mating-dance of bigpharmaco-starryeyedstartupco in the life science industry.]
The reason why it’s hard for companies to enter the R&D side and sustain their business without looking for a big pharmaco to buy them out is because it costs too much, from the cost of conducting human trials to filing all that paperwork and documenting and tracking on the regulatory side.
Think about the # of patients you’d need for a typical phase 2 cancer trial. Depending on the type of cancer you may be able to get away with a couple of hundred patients in the trial for the government to take your data seriously.
- Now you need someone, a principal investigator, to conduct the trial ($),
- usually a physician at a research-enabled facility that will charge you an overhead ($).
- You may need to help that clinical trial site increase awareness of the trial to patients ($).
- You may need to supply the drug to the patients ($),
- as well as other drugs as part of side effect management ($).
- Each patient has to be screened and a comprehensive medical history taken ($)
- and someone has to do that ($) who is usually not the principal investigator.
- There will be tests that need to be run during the trial itself ($).
- Sometimes patients get compensated ($).
- Often patient recruitment lags ($)…. and lags ($$)… and lags ($$$).
- Finally the clinical trial is completed the you pay the milestone payments to the investigator ($) as part of the research contract.
- Then the data needs to be presented at a large scientific meeting ($)
- and published in a medical journal ($)
…and we’re not even getting to the balance sheet of filing regulatory dockets for submitting the drug for approval.
Thus the challenge of realizing increased R&D competition to create viable alternatives is the cost of executing clinical trials and the need for organizational infrastructure to support these goals. Now we get into the true barriers to entry beyond innovation: we have organizational barriers and infrastructural barriers that amount to hefty cost barriers to entry into the cancer market.
In conclusion, cancer treatment will become unsustainable in wealthy nations because their population are likely to live long enough to develop cancers that will require next generation treatments, and because the current cost of developing cancer therapies through the human clinical trial process is increasing rather than decreasing.