The (High) Cost of Cancer Treatment: I

Every three weeks, always on a Thursday afternoon, I amble on over to the cancer center for my IV treatment.

(I also take Cytoxan, a chemo drug that comes in pill form, every day, plus a handful of other pills to help deal with the side effects and fringe benefits of being in cancer treatment—anxiety, high blood pressure, occasional depression, insomnia.)

The total bill for each treatment session at the cancer center is something north of $20,000. The annual cost of my cancer care is more than $300,000. That’s three hundred thousand dollars a year.

Almost $30,000 a month to keep me alive.

Here’s how the cost breaks down.

My bill from the Seattle Cancer Care Alliance (where I got my treatment until recently) for September 1, 2006—for three drugs, Herceptin, Avastin, and Zometa—was for $20,052.19.

The cost of the three drugs, listed as “drugs/detail code,” was $18,142.92. I asked at the pharmacy, and they told me that they charged me $6,254.95 for one dose of Herceptin, and an amazing $9,496.47 for one dose of Avastin.

In addition, SCCA charged me almost $2,000 to give me this one treatment.

That’s broken down into a total of nine line items, including “pharmacy” ($187.95), “IV therapy” ($233.75), “laboratory” ($180.50), “lab/chemistry” ($386.50). “chemotherapy IV” ($302.50), and so on.

SCCA also charges a markup on the chemotherapy drugs themselves, but I was unable to learn how much that is.

It’s enough to make me want to roll up my sleeve and do it myself!

Both Herceptin and Avastin are made by Genentech Inc., a San Francisco Bay Area company that is doing very well, thank you. The reason they are so expensive is that they are new, and there are no generic versions available. So Genentech can charge whatever it wants, without competition, for these life-saving drugs.

I need to do more research to find out how long it will be before other companies will be allowed to make generic versions.

Unfortunately, it won’t be in time to help me.

As a result of the high cost of Herceptin and Avastin, I am going to hit my lifetime max of $1 million on my health insurance before the end of 2007.

Then what? I can’t even afford a month’s worth of cancer treatment on my own.

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How much do you pay for cancer treatment? Send me an e-mail, I’d like to know. jeanne.sather@gmail.com

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USA Today ran a story in July on the high cost of cancer drugs that has dozens of comments from readers about how to fix the problem, including price controls. Can't argue with that one.

The article lists the cost per month of a number of cancer drugs, including Avastin and Herceptin. I'm not sure where USA Today got the numbers, but they appear to be too low. Herceptin, for example, costs about $3,000/month, according to the article, but my cancer center bills me $6,200-plus every three weeks.

The article says Avastin costs $4,400/month, while I am billed more than $9,000 every three weeks, but the article does note that this is the price when the drug is used to treat colon cancer. The dose for breast cancer treartment is larger, so the drug is more expensive.

The article questions whether or not these expensive drugs are worth it:

"These therapies may give patients a few more months, but they are not a cure. Given those limitations, Angell and others question whether the drugs are worth the price."

I do have to quibble with that one. Herceptin has helped keep me alive with metastatic disease for more than five years now, and I've added Avastin to that for the past year or so.

Those of us living with metastatic disease understand that we won't be cured, but as long as our quality of life is good, let's not talk about pulling the cord!

Prices soar for cancer drugs

@ Jeanne Sather 2007.

Comments

[jessica]

oh, jeanne, i am sincerely sorry that you have to add this worry to your plate. it angers and perplexes me, and odd as it may sound, makes me want to go and vote! let us all keep stories such as yours in mind as we elect leaders and enforce change.

you are in my thoughts...

[Jeanne]

Jessica--thank you. I think voting IS the right response. I'm actually going to Olympia, the state capitol, next week to lobby for better health insurance and health care.

It's been a long time since I've done something like this, but it sure feels like the right thing to do. So I'll be telling my story to some lawmakers.

Jeanne

[RubyShooZ]

These costs have just made my eyes bug out. Thanks for all you do Jeanne and I truly do appreciate the information you've been sharing here.

Would you mind if I post a link to your blog on mine? I think this is information that should be made known as publically as possible.

[jeanne]

Thanks, RubyShooZ--please add a link. Jeanne

[Greg Pawelski]

Anti-angiogenesis drugs work by blocking the activity of VEGF to prevent the growth of new capillaries into the tumor and thereby sustain tumor growth. VEGF causes angiogenesis by attaching to special receptors, and this action starts a series of chemical reactons inside the cell.

Avastin directly binds to VEGF to directly inhibit angiogenesis. Within 24 hours of VEGF inhibition, endothelial cells have been shown to shrivel, retract, fragment and die by apoptosis. Tumors which secrete relatively low levels of VEGF might be more susceptible to an agent like Avastin which works by blocking VEGF (Avastin "sensitive" tumors). It potently inhibits the formation of new blood vessels.

There is a "functional profiling" Microvascular Viability Assay for anti-angiogenesis-related drugs. A major modification of the DISC (cell death) assay allows for the study of anti-microvascular drug effects of standard and targeted agents. The assay is based upon the principle that microvascular (endothelial and associated) cells are present in tumor cell microclusters obtained from solid tumor specimens.

The assay, which has a morphological endpoint, allows for visualization of both tumor and microvascular cells and direct assessment of both anti-tumor and anti-microvascular drug effect. CD31 cytoplasmic staining confirms morphological identification of microcapillary cells in a tumor microcluster.

The principles and methods used in the Microvascularity Viability Assay include: 1. Obtaining a tissue, blood, bone marrow or malignant fluid specimen from an individual cancer patient. 2. Exposing viable tumor cells to anti-neoplastic drugs. 3. Measuring absolute in vitro drug effect. 4. Finding a statistical comparision of in vitro drug effect to an index standard, yielding an individualized pattern of relative drug activity. 5. Information obtained is used to aid in selecting from among otherwise qualified candidate drugs.

This kind of technique exists today and might be very valuable, especially when active chemoagents are limited in a particular disease, giving more credence to testing the tumor first. After all, cutting-edge techniques can often provide superior results over tried-and true methods that have been around for many years.

Source: Eur J Clin Invest, Volume 37(suppl. 1):60, April 2007

[Salvatore]

This is one of the main reasons for medical tourism. If cost is a problem then you should look into going abroad. You can go to Thailand, Singapore, or even Saigon, Vietnam. I know there is a very good oncology and nuclear medicine department at a French/Vietnamese hospital in Saigon www.fvhospital.com

For what it cost you I the States, you can buy a nice condo or bungalow and have your treatments at a hospital near a beautiful beach or business city.

[jeanne]

Salvatore--it's a thought. The only problem is, for me, I would have been living in Vietnam for nine years now! And my life is here.

Jeanne

[betty karen egelhoff]

Where can I get help for my cancer bills I have done the same as you but my bills sre getting worse and in this state they refuuse you if you can't pay.

[jeanne]

Betty--where do you live? And what cancer center do you go to?

If you don't mind telling me that, I'll see if I can help. No one should be refused treatment because they can't pay. That's outrageous.

Jeanne

[Sten]

I am shocked to read about your situation. In Sweden the whole treatment would be completely free for as long as you live. I also checked about costs:
Avastin 4 ml is 600 USD and 16 ml is 2000 USD coming from a US company! The herceptin in less than 1100 USD. Change your government to one that really means that life is precious

[Todd Farley]

Hello Jeanne i am sorry to hear about your situation i am a senior attending Camden Hills Regional High school in Camden Maine and am doing a 4th quarter report on conspiracies. i believe that there is a cure for cancer but because of the high cost it would be a huge financial deficeit for the FDA, and the pharmaceutical division. i found the numbers very high and not to surprising if you could send me any more info i would appreciate it. take care

[jeanne]

Hi Todd--Conspiracy theories? I'm not going down that road, sorry.

Jeanne

[Liz]

but u didnt tell what the total was, that didnt help at all!!!

[jeanne]

Liz--it's in the post--$20,000 for each treatment, and $300,000 for the year.

I'm no longer on this regimen, so my annual bill is somewhat less.

[Ken]

It is too bad there are no generics yet for these drugs. I am wondering if the time for generic companies to be allowed to create these drugs is shortened, and the companies that patent these drugs can't make as much money on them for as long, or if there are price controls put on these drugs, won't there be less new drugs coming to market because there won't be as much incentive to create new drugs for profit?

[shetu]

Sorry about this. I stop my mom's treatment for cost. :(

[Kimm]

I need everyone's help in a nightmare situation. The chemo drugs I was on have stopped working. My onc. wants to put me on a combo of drugs called Tykerb (GlaxoSmithKline) and Xeloda (Rosche). These drugs have a good and proven track record for treating my type of BC. Unfortunately, I'm not covered by my current insurance because they don't cover brand name drugs or specialty pharmacy drugs (thanks Anthem BCBS). I've applied to numerous financial assistance programs and am told I don't qualify because they only cover assistance with co-pay. These drugs are almost $6000 per month. Obviously, I can't pay for these out of pocket.

Now here's the thing. Sometimes breast cancer patients are put on these drugs, get the prescription filled and then the drug stops working for them and they then have a small supply of the drugs that they can't use. Usually these drugs get thrown in the trash. Sometimes they get "donated" to cancer clinics so they aren't wasted, but cancer clinics can't accept them because of legality issues. What I'm asking is that if you know someone who might have been on these drugs then please forward them this email. Also, please send this email to everyone in your contacts. What I'm asking you to do is technically illegal, so if you're not comfortable doing this then I completely understand. Sadly, for me, desperate times call for desperate measures.

Thank you for your time,

--
Kim Fernandez
Cell 812-345-5534

[Sam]

Hi, I'm including the cost of your treatment in a school speech I'm writing. If I knew a Canadian I would make them marry you so you could get free treatment. That is the hallmark of civilization. But we live in America...

[Jenn Leonard]

The horror I am feeling in regards to your situation is appalling. I understand that this post is now two years old, but even in early 2007... It appalls me that the pharmaceutical companies are legally permitted to put a price on life, and such a steep price, at that.

I browsed your blog in reference to a paper I am writing regarding the exorbitant cost of health care, particularly the realm of cancer. The info here has been most helpful, and I appreciate it.

I hope that you remain in passable, lively health, and that you remain with your wits and wallet. Peace to you and yours.

[Sally]

Cancer treatment is very expensive does anyone think it is wrong for a government to support a cancer patient? In Ghana, one such case exist but Ghanaian have criticize the cause even to the point where the patient has died and people are saying all sorts of unnecessary stories. if a country can actually support cancer patients it will be great there will be less death rates after all they are also tax payers so the tax payers money should be of benefit to them

[lyn melanoy]

Jeanne,
Something has to be done in this country regarding the high costs of cancer care. No normal, middle class American can afford the care. My husband just told me of one of his construction friends that lost their home due to the high medical bills from his wife's cancer. They now must live with family as they lost everything they owned.
While the greedy institutions take their big dividens, the patients, are left sky rocketing debt.
It is all about greed.