Medicare to pay for $93,000 prostate cancer drug

[Times Roman]

So the question I have is this.... is it ethical for medicare to spend up to $1billion next year so that some may live an additional 4 months? Is this the best use of our limited tax dollars? With our ballooning health care costs, is it responsible to spend such large amounts on such marginal results?

Read below....

WASHINGTON – Medicare officials said Wednesday that the program will pay the $93,000 cost of prostate cancer drug Provenge, an ********** therapy that typically gives men suffering from an incurable stage of the disease an extra four months to live.

The Centers for Medicare and Medicaid said the biotech drug made by Dendreon Corp. is a "reasonable and necessary" medicine. The decision ensures that millions of men would be able to afford the drug through the government-backed health care coverage. With government reimbursement, analysts estimate Provenge could rack up $1 billion in sales next year. The decision, which will be finalized by June 30, is important for Dendreon because most prostate cancer patients are 65 or older.

Medicare is legally prohibited from considering price when deciding whether to pay for a new treatment. The Food and Drug Administration approved Provenge last April and in most cases Medicare automatically covers drugs cleared by the agency. But Medicare's decision to review Provenge last year prompted outrage from some patients and doctors who said the government was looking for a reason to avoid reimbursing for the pricey drug.

The infused drug is a first-of-a-kind treatment in that each dose is customized to work with a patient's immune system. Seattle-based Dendreon says Provenge's price reflects the more than $1 billion spent researching and developing the drug. And prostate cancer patients point out that the median survival time with Provenge is double that of chemotherapy, which is about two months and is marked by significant side effects.

"It's impossible to put a dollar figure on a human life, especially when you're talking about a drug that has such mild side effects," said Jim Kiefert, a prostate cancer patient and advocate who was part of the Provenge study. "Of all the treatments I've had — with surgery, radiation and hormone treatment — Provenge had fewer side effects than any of them."

But bioethicists who study health care decisions say Medicare's ruling on Provenge mirrors the bias of the overall U.S. health system, which emphasizes expensive treatments over basic medical care. Health care costs account for nearly one fifth of the U.S. economy, more than any other country.

"We tend to put our health care dollars into very high-tech interventions that produce very marginal improvements," said Dr. Steven Miles, a professor at the University of Minnesota's Center for Bioethics. "The problem is that we have created a health care system that is uniquely inadequate in terms of access to primary health care, which is where you get the most bang for your buck."

A growing number of biologically engineered cancer drugs are being priced in the $100,000 range, including therapies from Roche and Eli Lilly & Co. Last week, Bristol-Myers Squibb Co. received approval for a new melanoma drug that will be priced at roughly $120,000 per patient.

Provenge is the first FDA-approved cancer drug that uses the body's own immune system to fight the disease, offering an alternative to chemotherapy drugs that attack cancerous and healthy cells at the same time. The treatment is intended for men whose prostate cancer has spread elsewhere in the body and is not responding to hormone therapy or radiation.

Each regimen of Provenge must be tailored to the immune system of the patient using a time-consuming formulation process. Doctors collect special blood cells from each patient that help the immune system recognize cancer as a threat. The cells are mixed with a protein found on most prostate cancer cells and another substance to rev up the immune system, and then given back to the patient as three infusions two weeks apart.

Industry observers say much of the scrutiny of Provenge stems from the current political climate, as voters push lawmakers to cut the deficit and rein in government spending. At the same time, the new health care reform law has stoked debate about how much say the government should have in approving coverage of medical treatments. Republicans have accused the acting chief of Medicare, Dr. Donald Berwick, of advocating health care rationing, based on statements he made as a professor at Harvard University. President Obama appointed Berwick to the post last year, but Senate Republicans have opposed his confirmation and have urged Obama to nominate someone else.

Dr. Sean Tunis, a former Medicare official, called Wednesday's decision a case of "the dog that didn't bark."

"You could almost guess that this would be outcome before they even started. So why raise all the anxiety and subject yourself to all the criticism of rationing?" said Tunis, who is director of the Center for Medical Technology Policy in Baltimore.

Medicare officials have said the agency's review of Provenge was aimed at clearing up bureaucratic confusion among Medicare carriers across the country, some of whom already pay for Provenge. Medicare on Wednesday called its online memo a "proposed decision," but it essentially amounts to agreeing to cover the drug for millions of seniors enrolled in its program.

The news sent Dendreon shares up 66 cents to $36.20 in after-hours trading. The stock closed the regular session down 34 cents at $35.54 before the announcement.

[wmaousley]

If paying for this drug will allow my grandmother/grandfather to be able to spend 4 more months on earth with me. I am all for it. 110%


BTW I watched my grandfather deplete his entire life savings into treatment of his prostrate cancer and lived 17 years after his cancer was in remission.

[lovbyts]

If paying for this drug will allow my grandmother/grandfather to be able to spend 4 more months on earth with me. I am all for it. 110%


BTW I watched my grandfather deplete his entire life savings into treatment of his prostrate cancer and lived 17 years after his cancer was in remission.

You are all for it at what cost and is it the amount of time or the quality of time that counts?
My mother was just diagnosed with Pancreatic Cancer last December. They have determined that it has already spread to much for them to be able to treat it and get rid of it. The doctor did tell her that if she wants she could have Chemotherapy done and it MAY prolong her life a few months or??? He also was good enough to tell her that it would also make her sick pretty much from day one and the Chemo alone could kill her before the cancer. She is 86 and always lived very healthy. Luckily she decided not to do the chemo and will do what she can to be as normal as long as she can instead of spending all her time, energy and life savings to live another couple of months.

I would do the same thing. Quality of life is more important to me than quantity. I think the money would be better spent on finding a cure instead of prolonging the suffering. My moms attitude is when it gets BAD and I am in pain 24/7 give me a pill to get it over with. I wont assist in something like that due to the consequences but I can understand her desire not to suffer if at all possible. Again, I would do the same. Even as a kid I always though if I had cancer or some incurable disease and I knew I only had a certain amount of time left I would make the most of it and then find a way to take myself out without hurting anyone.

Best thing someone can do who has limited time left is to live life that is left and make your peace with friends/family. Say your goodbyes. No one is meant to live forever.

[wmaousley]

You are all for it at what cost and is it the amount of time or the quality of time that counts?
My mother was just diagnosed with Pancreatic Cancer last December. They have determined that it has already spread to much for them to be able to treat it and get rid of it. The doctor did tell her that if she wants she could have Chemotherapy done and it MAY prolong her life a few months or??? He also was good enough to tell her that it would also make her sick pretty much from day one and the Chemo alone could kill her before the cancer. She is 86 and always lived very healthy. Luckily she decided not to do the chemo and will do what she can to be as normal as long as she can instead of spending all her time, energy and life savings to live another couple of months.

I would do the same thing. Quality of life is more important to me than quantity. I think the money would be better spent on finding a cure instead of prolonging the suffering. My moms attitude is when it gets BAD and I am in pain 24/7 give me a pill to get it over with. I wont assist in something like that due to the consequences but I can understand her desire not to suffer if at all possible. Again, I would do the same. Even as a kid I always though if I had cancer or some incurable disease and I knew I only had a certain amount of time left I would make the most of it and then find a way to take myself out without hurting anyone.

Best thing someone can do who has limited time left is to live life that is left and make your peace with friends/family. Say your goodbyes. No one is meant to live forever.

I agree with you 100%, I wasnt as specific as I should have been. If the cancer is caught at an early stage and can be treated with great chances of ridding the body of cancer then yes I will be all for paying for it and its quantity of life that matters because quality will improve over time.

If the cancer is at the stage where nothing is possible then the quality of life becomes a big factor, I have seen personally the affects of Chemo and its harsh. I would rather do what your mother has chosen to do and live life as normal as possible rather than being tied up with therapy and hospitals until the end.

[Times Roman]

this is a very late stage cancer treatment option that only extends life a short while at a very high cost. It is not set up to save life, just extend.

My big concern is this....

Assume for the moment that the government is willing to spend $1Billion to extend, in most cases, elderly gentlemen's lives a few months. Now, please understand that there is NOT an infinite supply of money! If we spend $1billion here, that means we ARE NOT spending $1billion somewhere else. If you had $1Billion to spend, would you really spend it THIS way? Also, please know that almost 85% of all health care dollars are spent on the patients final few months of life.

We as a society seem ill prepared to deal with one of the basic facts of life.... that with every beginning, there is an end. This includes life. The US spends horrendous amounts of it's resources trying to extend the lives of those that no longer have any quality of life, and so we hook them up to tubes, machines, and teams of people to care for them. And in return, the "Patient" gets an extension on a life that in a large number of cases, is no longer pleasant, and quite often, very painful.

You mention that you would give anything to have grandpa around for another few months. But I ask you... which grandpa? the one that took you fishing as a kid? or the one that is barely conscious in a hospital that has lost 35% of their weight, barely recognizable with the oxygen mask on and the IV tubes running into their arms. Because I tell you, in most cases, the Billions and Billions we spend every year is really spent, not on the grandpa that took you fishing, but the grandpa that is agonizing away in a hospital bed. Is this really what you want? Is this REALLY HUMANE?

[DSM4Life]

I hate the health care business more then the devil himself.

[DSM4Life]

this is a very late stage cancer treatment option that only extends life a short while at a very high cost. It is not set up to save life, just extend.

My big concern is this....

Assume for the moment that the government is willing to spend $1Billion to extend, in most cases, elderly gentlemen's lives a few months. Now, please understand that there is NOT an infinite supply of money! If we spend $1billion here, that means we ARE NOT spending $1billion somewhere else. If you had $1Billion to spend, would you really spend it THIS way? Also, please know that almost 85% of all health care dollars are spent on the patients final few months of life.

We as a society seem ill prepared to deal with one of the basic facts of life.... that with every beginning, there is an end. This includes life. The US spends horrendous amounts of it's resources trying to extend the lives of those that no longer have any quality of life, and so we hook them up to tubes, machines, and teams of people to care for them. And in return, the "Patient" gets an extension on a life that in a large number of cases, is no longer pleasant, and quite often, very painful.

You mention that you would give anything to have grandpa around for another few months. But I ask you... which grandpa? the one that took you fishing as a kid? or the one that is barely conscious in a hospital that has lost 35% of their weight, barely recognizable with the oxygen mask on and the IV tubes running into their arms. Because I tell you, in most cases, the Billions and Billions we spend every year is really spent, not on the grandpa that took you fishing, but the grandpa that is agonizing away in a hospital bed. Is this really what you want? Is this REALLY HUMANE?

edit. I dont even want to discuss it that how pissed off it makes me.

[Times Roman]

^ I agree with you... we have it all completely backwards. The amount of money we spend per person on health care is staggering... spending money is NOT the problem. If we just spent our money wisely, instead of spending hundreds of thousands on someone that is about to die, we could spend it on the living and on quality of life issues. Imagine everyone with health care.

Even the people that are dying, acknowledge (a good chunk of em) that instead of wasting huge amounts on them just so they can hang in there a few more weeks or a month or two, instead, spend it on a kid that needs a liver transplant, or a heart operation.

But oh, no! Allowing someone to pass on their own timetable and their own terms just wouldnt' be right, now would it?

[DSM4Life]

We should have the right to legally end our lives anytime we want. Video tape the confession, the death and i am all for it. As much as i hate healthcare it would be cheaper for them to kill someone then to try and sustain what little life a dying person might have. Therefore they (healthcare) should even cover the killing charges ! Only problem with giving the healthcare this "god like" power is they will abuse it. Soon people would be put to death for a stubbed toe because it would be cheaper to kill you then you buy you a band-aid.

[Times Roman]

The decision should always be the patients. Part of the problem is our hypocratic oath...." do no harm".... assisting in suicide has been legally challanged as opposing that oath, unfortunately