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Would You Pay $475,000 for the New CAR-T Cancer Treatment?

How much is a life worth? Will new cancer treatments bankrupt the American health care system? CAR-T gene therapy is revolutionary, but can we afford it?
Would You Pay $475,000 for the New CAR-T Cancer Treatment?
A female cancer patient with no hair,

The hottest new cancer treatment is called CAR-T. It stands for chimeric antigen receptor (CAR) T-cell therapy. Many world class medical centers have gone all in on CAR-T cancer research. That’s because there is great hope that this new form of personalized immunotherapy could represent a dramatic improvement in hard-to-treat cancers. Is CAR-T worth almost half a million dollars?

ALL Treatment

Imagine for a moment that someone you loved was diagnosed with a deadly cancer called acute lymphoblastic leukemia (ALL). This is a blood cancer. The bone marrow churns out way too many immature white blood cells (lymphocytes). They are unable to do their job fighting infection. As more and more leukemia cells are produced, fewer healthy lymphocytes can be made. Symptoms include easy bruising, fever, joint pain, swollen lymph nodes, fatigue and weakness.

In the past, treatment for this kind of leukemia has involved potent chemotherapy drugs and powerful corticosteroids (dexamethasone or prednisone). There are additional drugs that sometimes help such as Gleevec (imatinib) or methotrexate. The cure rate for adults is usually around 40 percent.

If this kind of leukemia relapses the prognosis is not good. When children or young adults experience a return of ALL, their anticipated lifespan is measured in months, not years.

CAR-T for ALL: Is Kymriah Worth $475,000

What price do we put on a life? That seems to be the question the pharmaceutical industry is now asking. There is tremendous excitement about CAR-T because the early word on the street is that it could represent a cure for some people. This new cancer therapy is the first FDA-approved gene treatment for leukemia. Novartis has named its CAR-T treatment Kymriah.

This therapy involves harvesting T cells from the patient. These specialized immune cells are then modified to produce chimeric antigen receptors (CARs). The CAR-T cells are then allowed to multiply. When there are millions and millions of CAR-T cells they are infused back into the leukemia patient’s bloodstream where they are supposed to home in on the cancer cells and kill them. This sort of immunotherapy has many cancer researchers excited because they have seen results in some patients that have been nothing short of miraculous.

An Inside Story on Drug Prices:

Decades ago an executive at one of the country’s leading pharmaceutical companies confided to us that the industry was facing a crisis with regard to drug pricing. The first AIDs drugs were becoming available and companies were charging what seemed like outrageous prices.

The initial price tag for AZT in 1987 was $10,000 a year. That was considered shocking. AIDs activists and public health experts were up in arms. Civil disobedience protests over the price forced the company to lower the price to $8,000 a year.

The Impact of Push Back:

Our insider into drug company negotiations told us that he and other executives sat around a table in the 1980s and discussed pricing in general and cancer drug prices in particular. These pharma folks were taken aback by the public outcry over the price of AIDs drugs.

They admitted to themselves that if a company came up with a cure for cancer it would have to be very cautious about the price it charged. There was even a suggestion that the industry would have to give away such a miraculous medicine. Otherwise, the entire pharmaceutical industry might be tarnished. The rebellion over the cost of AIDS drugs suggested to these various executives that the public would not stand for price gouging. That was then.

Today, drug companies routinely charge anywhere from $100,000 to $150,000 for new immunotherapy cancer drugs. We suspect that the $475,000 price tag for Kymriah is a trial balloon. There are many other companies researching CAR-T therapies for other cancers. If Novartis can get away with charging nearly half a million dollars, then other companies are likely to see that as the new benchmark, too.

Can We Afford New Cancer Drugs Like CAR-T?

Even if someone has great insurance, there are collateral expenses associated with CAR-T. Patients often have to stay close to the medical center for weeks or months after they get their CAR-T infusion. That’s because side effects of this therapy can be life threatening.

The immune system sometimes goes wild. A massive release of chemicals called cytokines can trigger high fevers and very low blood pressure. Serious infections are another worrisome complication. Brain swelling can lead to seizures and other neurotoxicity. These adverse reactions are often treated with large doses of corticosteroids, which also carry significant side effects.

Insurance companies that agree to pay half a million dollars for CAR-T therapy will doubtless raise their premiums. Patients who do not get approval from their insurance companies will have to face a terrible dilemma: Beg or borrow hundreds of thousands of dollars or watch a loved one die. In our opinion, that is unconscionable.

What if There Were a Cure for Alzheimer’s Disease?

Most people have been touched by dementia. Have you watched helplessly as a friend or family member slowly descended into forgetfulness. What would you pay to keep that person out of a nursing home? What if we could keep that individual from disappearing down the rabbit hole entirely?

We suspect that the first truly effective medicine against Alzheimer’s disease might come with an unbearable price. The drug company would likely charge more than $100,000 a year. It would justify the cost on the grounds that nursing home care can cost almost that much, if not more.

Multiply $100,000 times 5 million people with Alzheimer’s disease. That comes to:

$500,000,000,000,000

That’s theoretical. But it is more money than any country could afford.

Now consider the cost of cancer drugs at $500,000 per treatment. How long can we sustain a health care system with prices like that? We suspect that the entire system will implode within a few years if we do not get costs under control. Breakthrough drugs like CAR-T are great…if they are affordable. If our entire health care system sinks under the weight of such advances, we’re all in trouble.

What Do You Think?

We would love to hear from you. Are new cancer treatments worth hundreds of thousands of dollars? We all want new and better cancer therapies. Can we afford them? Share your thoughts in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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