Why are oncologists and the League rebelling?
In recent years, new particularly effective cancer treatments have appeared: targeted therapies and, more recently, immunotherapy. These molecules represent real progress. Some offer patients hopes of longer survival and a better quality of life. However, the cost, initially increasing, and now exorbitant, of these innovations is likely to compromise these hopes, warn oncologists. In fact, treatments that cost €50,000 a year are becoming more and more common.
Is the price hike justified?
Laboratories are businesses: their objective is therefore to make a profit. “It’s not about blocking their profits. But today, we feel that the research and development costs have a good back and do not justify the current prices, says Professor Jean-Luc Harousseau, professor of hematology. The price of cancer drugs should not be used to bear the cost of future research, nor that of failures encountered with other molecules. » In addition, for oncologists, the prices do not have to be set with regard to possible savings on other health items. The price of anti-tuberculosis drugs that appeared in the middle of the 20th century was fortunately not defined according to the years in the sanatorium and the deaths avoided…
Who sets drug prices?
The laboratories retain the costs of research and development, which include the research of the molecule, the studies on animals and on humans. Then they take into account the number of patients concerned and the lifespan of the product. The more the drug is intended for a few patients for a limited time, the higher the asking price. For oncologists, these prices are determined by the idea that manufacturers have of what the markets are capable of supporting. Hence the very significant price differences observed from one country to another.
In France, each laboratory negotiates its price with the CEPS (Economic Committee for Health Products), which brings together representatives of ministries and health insurance. The Transparency Committee previously assessed the therapeutic benefit of the drug compared to existing treatments. And “for the past two years, for innovative but very expensive drugs, the additional cost compared to existing treatments per year of life gained in good health has also been taken into account” , specifies Professor Harousseau.
How are these treatments supported?
In the United States, where the prices are the highest, some patients are not insured and, when they are, they may have to pay for part of their medication. In England, it is the cost of a year of life gained that determines the coverage: beyond a certain price per year of life gained, treatments are no longer reimbursed. Result: 17 cancer drugs are no longer prescribed. The solidarity health plan from which we benefit in France is protecting patients for the time being. But for how long ? , are alarmed oncologists. The daily “Le Figaro” cites the case of the Léon-Bérard cancer center in Lyon, which decided to no longer administer Yondelis® to new patients suffering from rare sarcomas: the drug had been removed from the “list in addition”, which guarantees reimbursement by health insurance. This represented, for the centre, an additional cost of one million euros for around twenty patients. Financially impossible.
What solutions for the future?
The debate is open and several avenues can be considered. The simplest, already implemented in certain countries such as Italy and, in France, for a few molecules, is payment by performance. If the drug is effective in 40% of patients, the laboratory reverses the overpaid turnover (that is to say, in this example, 60%). Other possibilities: setting different prices, for the same drug, according to its interest according to different indications or even reimbursing a stage of treatment (paying for the treatment or treatments used at a given stage…) But we will not escape probably not to the ethical debate on the cost to society of a few months of life gained in patients with very advanced cancers.
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What the labs say Éric Baseilhac, director of economic affairs at Leem*: For Leem, which represents pharmaceutical companies, the cost of innovative drugs is explained by the inflation of research and development expenditure ( R&D) . More particularly at the time of the development phase, that is to say when we move on to clinical studies on humans. “In oncology, development expenditure represents two-thirds of R&D, and it has increased by more than 10% per year in recent years, in particular due to regulatory requirements regarding clinical trials” , says Dr Éric Baseilhac, director of economic affairs at Leem. Without denying the need for a debate, for Éric Baseilhac: “The arrival of new molecules will also generate savings that must be taken into account. For example, oral chemotherapies allow patients to be cared for at home. » |
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