Living longer with cancer carries a price

Helen Palmer Sep 12, 2006

KAI RYSSDAL:


CINDY BASS: I was a legal secretary until I was diagnosed with lung cancer.

HELEN PALMER: Cindy Bass is a feisty New Yorker who likes bright-colored beaded blouses and dangly earnings. Her health insurance covered her treatment.

BASS: I started with surgery — I had part of my lung removed — then maybe a year after that I had a short session of chemo.

Six months later, more chemo. Then along came one of the magic new drugs, Iressa. Bass was part of an investigational study of the pill.

BASS: I was getting the pills without having to pay, which was very nice because they’re very expensive.

Then an even better and even more expensive lung cancer drug came along, Tarceva. Bass got that free from the drug company too, until she turned 65 and became eligible for the Medicare Drug benefit.

BASS: Tarceva with insurance is $1,400 or so a month — that’s my co-pay. Without insurance it’s $2,400 to $2,500 a month.

The restrictions of the drug benefit meant Bass was faced with that full $2,500 bill by the second month.

BASS: I panicked, I really did. I’m a middle class person. I’m single. I don’t have a pension, I only have what I earned. I could do it with difficulty and wipe out my savings.

Bass’s experience is not unique. Jane Levy of the advocacy group Cancer Care says they get hundreds of calls from panicked patients desperate for help.

JANE LEVY: Patients tell me that paying for the treatment is more anxiety provoking than the diagnosis. It’s very frightening. It impacts on every aspect of their life — how they’re going to manage financially.

Even patients with insurance can face co-pays of thousands of dollars. But the cost of these drugs isn’t just a problem for individual patients. There’s the question of whether the country can afford them.

TOM LYNCH: I would argue that drugs that prolong survival in general have been found to be something that society is willing to pay for.

Tom Lynch is head of thoracic oncology at Massachusetts General Hospital. He says the drugs do prolong life – for some. That could mean people need to take these drugs long term – at a cost of $30 or $40,000 a year.

LYNCH: I can tell you as a physician I don’t think at all about the cost of the drug. I think that my responsibility is to the patient to offer the therapy that I think is the most effective.

The new therapies are less toxic than chemotherapy, with fewer side effects. Ken Kaiten of Tufts University’s Center for the Study of Drug Development says they deserve their premium prices.

KEN KAITEN: Treatment with pharmaceutical products tends to be the most cost-effective mode of therapy, not just in cancer chemotherapy.

That’s certainly what the drug companies argue. They say cancer therapies eat up only 1 percent of the country’s total health care bill. Targeted therapies cost much the same as the latest chemotherapy regimens, anywhere from $30,000 to $60,000 a treatment, but they’re hugely profitable. Genentech makes four of these therapies. They helped the company earn $6.5 billion last year. That’s one reason Genentech also gave away $200 million of drugs to 18,000 patients. That’s how Cindy Bass got her lung cancer drug, Tarceva. But for her that’s only half the story.

BASS: I had a test and it showed some new growth, so they want to get it out. So I’ll be doing radiation and chemo.

The new, targeted therapies shrink tumors, but they’re rarely cures. The experts say to really control cancer we’ll need cocktails of these therapies, much like AIDS drug cocktails. And since nearly half of Americans will be diagnosed with cancer in the course of their lives, that could push the limit of what we can afford.

In Boston, I’m Helen Palmer for Marketplace.

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