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Business News: Cancer Drug Prices Disputed --- Memorial Sloan Kettering creates calculator that weighs factors such as side effects, years of life

The Wall Street Journal 

Peter Loftus

19 June 2015

Copyright © 2015, Dow Jones & Company, Inc.

One of the nation's top cancer hospitals is challenging the pharmaceutical industry to adopt a more rational approach to drug pricing.

Memorial Sloan Kettering Cancer Center in New York has created an interactive calculator that compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as the side effects the drugs produce, and the amount of extra life they give patients. In many cases, the website calculates a price that is lower than the drug's market price.

The project, led by Peter Bach, a physician and director of the hospital's Center for Health Policy and Outcomes, is the latest salvo from doctors and others against the escalating costs of cancer drugs, which increasingly carry price tags of $100,000 or more per patient for a year or a course of treatment. A colleague of Dr. Bach's at Memorial Sloan Kettering recently blasted cancer drug prices as excessive in a speech before thousands of cancer doctors at a meeting in Chicago.

In an interview, Dr. Bach said prices for many new cancer drugs don't reflect their value to doctors and patients. "Right now, manufacturers have total price control, and total control of prices has led to irrational pricing behaviors," he said.

To model what he calls "value based" pricing, Dr. Bach created the "DrugAbacus" research tool, which he hopes will get drug makers, insurers, doctors and patients talking about the factors that should determine price.

"We could have a value-driven system for pricing cancer drugs and probably other drugs, and here's a first draft of how to do it," he said.

The home page of the website ( features images of Merck & Co.'s melanoma treatment, Keytruda, and Novartis AG's Gleevec for a form of leukemia. The site lists their per-bottle price -- $2,500 for Keytruda and $9,000 for Gleevec -- and then asks: "But is that the right price? Should they cost more? Or less?"

The calculator is presented in the form of an abacus with two beads on each wire representing two different prices: the actual price as an immovable bead, and the "abacus" price, which slides up or down based on different factors chosen by the user.

For instance, a user can select what he sees as the monetary value of an additional year of life, ranging from $12,000 to $300,000. Other adjustable components include a "toxicity discount," which lowers the price to reflect the severity of drug side effects; and cost of development, which can move the price higher based on the number of patients in clinical trials.

When the value of a year of life is set at $120,000, with a toxicity discount that subtracts 15% off that level, the abacus price for many of the drugs is lower than the actual market price. A few have significant gaps at those settings, including Amgen Inc.'s Blincyto, approved by the U.S. Food and Drug Administration in December for the treatment of a rare type of leukemia. The market price for Blincyto is listed on Dr. Bach's site as $64,260 a month, but the suggested abacus price is just $12,612.

Dr. Bach said Blincyto should be discounted because many patients must be hospitalized to undergo the start of treatment to allow monitoring for side effects, which adds to the cost of administering the drug.

An Amgen spokeswoman said Blincyto is the first major treatment advance for patients with a rare type of leukemia, who typically live just three to five months after diagnosis.

"The price of Blincyto reflects the significant clinical, economic and humanistic value of the product to patients and the health-care system," the Amgen spokeswoman said. "The price also reflects the complexity of developing, manufacturing and reliably supplying innovative biologic medicines."

Dr. Bach has previously challenged the drug industry on prices. In 2012, Memorial Sloan Kettering decided not to give Sanofi SA's new drug, Zaltrap, to colorectal cancer patients because Dr. Bach and other doctors there believed its efficacy didn't justify its $11,000-per-month price tag. The doctors wrote a newspaper editorial laying out their decision. Sanofi subsequently cut the price by 50% for U.S. oncologists.

Dr. Bach said he got the idea to develop a price calculator in meetings he has had with drug companies, insurers and patients, during which he started writing down various components of what should determine price. Dr. Bach stopped seeing patients about four years ago to focus on research, but says he was also inspired by hearing stories of patients who didn't fill prescriptions because they couldn't afford the out-of-pocket costs, which are linked to the overall price.

Dr. Bach and two workers in his office spent much of the past two months setting up the site, with help from contractors at Real Endpoints, a drug-cost analysis firm, and engineers from software firm NetQuarry. Memorial Sloan Kettering funded the costs, which Dr. Bach estimated were in the "low six figures."

Some drugs fare well on the abacus when set at $120,000 for a year of life, and a 15% toxicity discount. Teva Pharmaceutical Industries Ltd.'s Treanda treatment for blood cancers has an "abacus" price of $21,227 a month, well above the actual price of $7,725. A Teva spokeswoman said the company is pleased to see Treanda's value to patients recognized.

Daniel Goldstein, a medical oncologist at Winship Cancer Institute of Emory University who has researched cancer-drug pricing, said Dr. Bach's site provides a starting point for value-based pricing.

"Currently cancer drug prices are not linked to the benefit they provide," Dr. Goldstein said. "They're currently priced on what the market can bear, which is an unsustainable system."

Patricia Danzon, a professor of health-care management at the Wharton School of the University of Pennsylvania, said assigning a monetary value to an additional year of life and discounting a drug's toxicity should be key components of any pricing system.

But she said she takes issue with the online calculator's inclusion of such factors as a drug's novelty, or its cost of development.

License this article from Dow Jones Reprint Service

Dow Jones & Company, Inc.




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Hi everyone

my name is Kelly I'm 29 from highlands in Scotland uk.

im new to this site although not completely new to melanoma but a bit clueless! I had primary removed from my arm in 2013 stage 2a, nodule appeared 2014 beside original site removed and still 2a clear ct scan, may2015 routines an showed 5 small tumours to my liver no lyphnodes involved braff wild,

i started ippy on the 1/6/15 about a week after I started getting horrific bruising with lumps, I have spoke to serval people about this all but one seems to think it is a side affect, my surgeon whom I spoke with last night thinks they are little tumours called subq.

im really just asking all you super warriors if you'd have had subq pop due to ippy or do you think they would have popped up regardless? Also I was wondering what everyone's thoughts were on all the new clinical trials and what has been most successful? 

Much love

kelly xx

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Mom2Addy's picture
Replies 1
Last reply 6/19/2015 - 7:08am
Replies by: Bubbles

My husband had SRS on two brain mets in Jan, surgery to remove 5 subcutaneous nodules and four treatments of Yervoy. His PET scan two weeks ago showed two additional nodules and something in his stomach. He had an endoscopy last Friday and a 24mm nodule removed which we found out today was positive for melanoma. Has anyone else had it in the stomach and if so, what course of treatment did you follow? Yes, we are with a melanoma specialist but won't see him until the week. He's also BRAF positive. Thank you! 

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Anonymous's picture
Replies 0

Has the scientific team at MRF, or any other the other MRF analogues, reviewed/analyzed/commented on the data presented by NWBio at ASCO this year regarding the DCVax phase 1 trial? Seems like they're honing in on an effective deliver method and interestingly it looks like it could be effectively used prior to PD1 treatment. 


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dentholla's picture
Replies 5
Last reply 6/22/2015 - 8:54pm
Replies by: dentholla, Bubbles, Speedster, Anonymous

My husband begins his trial this coming Tuesday as Stage 3b and it is not clear to me how much information can be made available to us.  For example, can we still ask that his positive sentinal node be tested further or that he be tested for BRAF?  I don't know if any of this has been done already or what his bloodwork looks like for that matter.  Perhaps I'm not being aggressive enough or asking the right questions.  I would appreciate any feedback on this so we are prepared when we go on Tuesday. 

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Replies by: sharebear, Rita and Charles, Patina, Anonymous

Thank you to everyone that responded to my post last night - we are dazed with the news and reading that everyone is still fighting and ALIVE is a relief.  Our oncologist is the Director of Cancer hospital at Scripps Green Hospital in San Diego......but we didn't ask if he is a melanoma specialist, we wil. 


Does anyone have a San Diego referral for a Melanoma Specialist?


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I hope your husband is doing better. Either NIH or mda or whatever path you folks have decided.


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Ericaloney78's picture
Replies 2
Last reply 6/21/2015 - 11:08am
Replies by: Becky

Hello, my name is Erica and I have posted before about my mom have Oral Mucosal Melanoma.

I want to bring us all together. I have been posting everywhere people with melanoma are to share with them my new FB PAGE. If we all have a meeting place specifically for MM then it's easier... Please come to

thank you so much and see you there!

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Hello, my name is Erica and I have posted before about my mom have Oral Mucosal Melanoma.

I want to bring us all together. I have been posting everywhere people with melanoma are to share with them my new FB PAGE. If we all have a meeting place specifically for MM then it's easier... Please come to

thank you so much and see you there!

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Edemk's picture
Replies 2
Last reply 6/17/2015 - 8:49pm
Replies by: Edemk, Janner

Hi all- a few days ago I received a call from my dermatologist who had three lesions on my breasts biopsied . One on the upper part of the left Breast and two on the underneath part of the Breast. He removed them after noticing that they had grew from the last time I visited him which was 3 years ago. The results he said were melanoma in situ. He said not to worry but referred me to a surgeon at NyU who he recommended should remove them by margins to be safe that everything is gone. I'm very concerned about this, I have a newborn daughter and very scared that bc I have not been to see the dermatologist, they have grown and spread. How can I be sure that it's in situ only??


Also my other question is once I remove all 3 by this surgeon, what is the likely hood that it comes back? Can I have Breast cancer bc of this? I apologize if I am asking ridiculous questions but as of right now this is all the information I have. The dermatologist assured me that the pathology reports were done by the president of the cancer board and he takes her word on everything that he sends over bc of her success rate in determining outcomes. 


Please se let me know what you all think. 

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Anonymous's picture
Replies 1
Last reply 6/23/2015 - 2:14am
Replies by: Anonymous

I have been in a clinical trial for for 2 years in Washington D.C..I'm about to begin my third year.  I have just been reassigned to Dr. Geoffrey Gibney who was recently at the Moffitt Cancer Research Center in Tampa, Florida.  I would appreciate any information about your experiences with Dr. Moffitt.  Thank you.


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He has had the biopsy, and the PET scan. The PET showed lymph nodes "lit up" closer to the heart area. The original nodule that started us on this path is mid lobe.  We met the oncologist yesterday, and the surgeon today. Still no defined answers.......the surgeon is taking it to the tumor board to see if removing the mid lobe and all the lymph nodes is the answer....


He also spoke of not doing a "local approach" of removing the mid lobe if the lymph nodes are too affected - needed to get a systemic approach.  We now wait again, and learn more on Monday on the plan they suggest for us. It's crazy,, my husband feels fine! he experiences some shortness of breath at times, and his voice gets gravely. BUT the surgeon pointed out that the nodes next to the vocal chords didn't "light up" so almost to say that Charles' gravely voice might be a manifestation of too much internet searching on symptoms. I know that it not the case becuse even before he was ever biopsied his changing voice Irritated the shit out of me......I kept telling him to clear his throat.


So I guess what am I asking?  We are still so early in the journey.....but the elephant in the room is how long will he live if diagnosed with stage 4 melanoma in lung and in lymph nodes?  No one has a crystal ball.....but.....should we run away to an island and spend time creating memories if life expectancy stats are dismal?? Just thinking out loud.......any feedback to us is great.


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Nell's picture
Replies 11
Last reply 6/23/2015 - 7:20pm

I am nervous to begin this targeted therapy after reading all the side effects that are possible, but I will begin taking the pills next week. Any advice..good or bad ..any encouraging words....or warnings....personal experiences ...will be so appreciated.  Stage 4 melanoma is really scary, but I am heartened by new treatments that are coming..and by the support of this forum . Thank you for your help. This is a place I know I can trust.          Nell

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