OBR Daily Commentary

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At $475,000, New Cancer Drug Raises Thorny Questions About Drug Pricing — And Value

(STAT/The Pharmalot View) Sept 4, 2017 - A first-of-its-kind cancer treatment is generating unbridled excitement — but also underscoring intense concerns over pricing and value.

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Thomas Marsland, MD (Posted: September 05, 2017)

quotesWOW...that is a hunk of change...BUT it would appear that Novartis is at least following some of the suggestions in the recent ASCO paper on drug prices. They would appear to be looking at whether the drug works or not as part of the pricing. In addition they are also considering different pricing for different diseases with different efficacy and hence a somewhat different value proposition. Both approaches suggested in the ASCO report. With that said, $475,000 is still a heck of a lot of money. There is still very much a lack of transparency in how they came up with that number. It is interesting the market was predicting even higher pricing so this number makes them look good. They quote a billion dollars in investment but that is the number quoted for any new drug so why the huge pricing difference for this drug compared to other new innovative cancer therapies. Clearly Novartis has taken some steps toward better drug pricing but no question we still need to do better at controlling new drug costs (some old ones too...) quotes

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A Cancer Conundrum: Too Many Drug Trials, Too Few Patients

(New York Times) Aug 12, 2017 - With the arrival of two revolutionary treatment strategies, immunotherapy and personalized medicine, cancer researchers have found new hope — and a problem that is perhaps unprecedented in medical research.

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Thomas Marsland, MD (Posted: August 17, 2017)

quotesSo I actually had the chance to read this article in the Sunday Times while traveling (am usually more of a WSJ guy). I think it raises a number of interesting points. One is the idea of how many drugs in a given category do we really need? Are 20 check point inhibitors really necessary? Yet every company wants to have one of their own. I would respectfully suggest that after the first two or three drugs in a given category, if efficacy is comparable, that cost as part of the value proposition should be considered in the approval process. If it costs less then it should be approved. Clearly one of the issues is that we need to put more patients on trials. In adult community oncology we put as an average only about 5% of patients on trials. We should undertake a national initiative to increase this number significantly. Why not 15% or more??? As the cost of treatments escalates it is even more important that we have the right drug for the right patient at the right time. Only through research and clinical trials will we be able to do that. With that being said we therefore need to make trials more available and easier to use in the community. Trial design looking at alternate marker outcomes for target treatments will result in shorter, less costly trials requiring fewer patients. As I said in one of my other comments, having clinical trials available in my new practice has gone a long way toward making it more fun again. quotes

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Oncologists Still Avoid Discussing Cost of Care

(Medscape Medical News) Aug 7, 2017 - Many professional medical organizations that provide guidance for cancer care now advocate a discussion of cost, including the American Society of Clinical Oncology (ASCO), which has urged physicians to do so since 2009. Few clinicians do, however, according to several sets of data.

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Thomas Marsland, MD (Posted: August 10, 2017)

quotesSo I usually do not even know the exact cost of the drugs. I believe for me and many of us this is a carry over from the days that chemo was a revenue generator for the practice and I did not want to be biased by potential income and wanted to base my treatment recommendations based on the effectiveness and toxicity of the drugs. With that said I am aware of the general expense of the drugs and will often tell patients that the treatment is "expensive." Indeed we do make treatment choice today based on cost, especially in relation to whether the treatment may fall under the medical or pharmacy benefit package. We do have financial counsilors in our practice who can and do have the expertise to make patients aware of the cost of therapies. It really is unrealistic to expect the doc to spend a lot to time talking about drug cost and insurance benefits, things about which we really know every little when our time is much better spent discussing the patient's disease, treatments, and outcomes. The recent NCCN review of patient concept of value confirms that what they really want is time with the physician to discuss their outcomes. Clearly cost is a key piece of the value proposition but it is not the only one and I believe patients are better served discussion cost and coverage with our financial councilors who are better trained to do this than me.quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Associate Cancer Center Director, Yale Cancer Center P...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

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Michael G. King Jr.

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Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

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Ted Okon

Executive Director Community Oncology Alliance...

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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

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Winston Wong, PharmD

President, W-Squared Group...