Dendreon's Provenge Costs the Same as Chemotherapy
The price of the prostate cancer drug has been widely debated and is often wildly wrong.
The following table uses data from the Alemayehu paper, numbers from a more complete analysis of chemotherapy costs from the Milliman firm, and actual Provenge costs to place the cost analysis in proper perspective.
I reiterate, the Alemayehu paper is inappropriate for cost comparisons because a substantial number of patients it tracks chose no therapy for CRPC. Comparing the cost of Provenge (or any other therapy, for that matter) against the cost of doing nothing is hardly fair or accurate. I included the Alemayehu column only to illustrate where Longo made his second error.
I should discuss the Milliman data briefly. The report wasn't specific to prostate cancer, but included prostate cancer as a separate data set. It looked at chemotherapy costs across a wide variety of cancers. The data were generated off a very large insurance database. Unlike the Alemayehu paper, it focused only on patients treated with chemotherapy and excluded those who didn't make that choice. It captures more side effect cost data by using primary and secondary codes for cancer/chemo-related treatments whereas the Alemayehu paper used only primary. The Milliman analysis does exclude patients over 70, which I believe likely underestimates the true cost of chemotherapy side effects since all the data I've seen shows people over 70 have higher and more severe side effects to Taxotere. The Milliman analysis doesn't make any attempt to segregate chemo use in CRPC from chemo use in earlier-stage disease. I don't believe this can account for the marked difference in cost PPPM compared to the Alemayehu since chemo is rarely used in earlier-stage prostate cancer (unlike almost all other cancers).
Most likely, the majority of PPPM cost differences between the Milliman analysis and the Alemayehu paper result from Alemayehu's methodology that captures "no-cost" patients who declined to receive chemotherapy for CRPC. It's worth repeating that this is a majority of patients, somewhere between 50% and 75% depending on the analysis. This choice doesn't represent a flaw in Alemayehu's methodology, but does mean the paper is unsuitable for use in comparing treatment costs.
I remain unconvinced calculating cost per median month survival is an effective method of cost comparison. Even though the table above shows the monetary cost of Provenge is comparable to the monetary cost of chemo in prostate cancer patients, this analysis ignores the radical difference in quality of life. I summarize a few of these quality-of-life differences in the table below.
Provenge is priced equivalent to the inclusive monetary cost of chemotherapy according to the Milliman data. This is somewhat ironic given the recent focus on Provenge's "high" cost. When one looks at even the brief side effect comparison I show above, it's easy to see why men are clamoring for Provenge and why the majority refuse to take Taxotere. It should also be easy to see why simple comparisons of monetary cost don't represent the entire difference between two therapies.
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