Leonard A. Zwelling

Cancer Drugs in the United States: Justum Pretium—The Just Price

In 2011, health care spending in the United States was estimated at

The clinical features of hepatic angiosarcoma: A report of four cases and a review of the English literature

2.7 trillion,1 making it the sixth largest economy in the world, larger than the national budget of France. National health care spending is approximately 18% of the US gross domestic product, more than

Mutagenicity, cytotoxicity and DNA crosslinking in V79 Chinese hamster cells treated with cis- and trans-Pt(II) diamminedichloride.

8,000 per person, compared with 6% to 9% in Europe and elsewhere, with apparently similar patient outcomes. Total Medicare expenditures in 2011 were

A Survey on Data Reproducibility in Cancer Research Provides Insights into Our Limited Ability to Translate Findings from the Laboratory to the Clinic

549 billion.2 A study comparing the Canadian universal health care program in older patients with the Medicare program in the United States suggested that adopting more-prudent health care strategies could have saved

Inhibitors of poly-(adenosine diphosphoribose) synthesis slow the resealing rate of x-ray induced DNA strand breaks

2.56 trillion from 1980 to 2009, or approximately one fifth of our national debt, without compromising benefit.3 In the debate about health care and Medicare solvency, strategies that reduce health care costs without compromising treatment efficacy and patient safety should be explored. Several experts have addressed health care costs in excellent analyses and editorials,4–9 but their efforts have not translated into concrete decisions and results that benefit patients, providers, insurers, or payees. However, an interesting exception occurred recently when Bach et al,10 in a New York Times editorial, compared the efficacy and cost of two anticancer agents—ziv-aflibercept (Zaltrap; sanofi-aventis, Bridgewater, NJ) and bevacizumab (Avastin; Genentech, South San Francisco, CA)—in the treatment of metastatic colorectal cancer. After noting ziv-aflibercept had similar efficacy but was twice the cost of bevacizumab, they stated it would be excluded from their hospital formulary.10 Within 1 week, sanofi-aventis, the company producing ziv-aflibercept, reduced its price by 50%. Thus, expert review of anticancer therapies for their cost-benefit ratios may influence institutional usage and drug pricing while preserving a healthy profit margin for pharmaceutical companies. Aristotle is credited to be the first to discuss the relationship between price and worth in his book Justum Pretium—the just price. Sixteen centuries later, Saint Albert the Great and Saint Thomas Aquinas refined Aristotles argument. Their conclusion: of moral necessity, price must reflect worth. In the context of cancer therapy, the prices of new anticancer agents seem to be decided by pharmaceutical companies according to what the market will bear. There is little correlation between the actual efficacy of a new drug and its price, as measured by cost-efficacy (CE) ratios, prolongation of patient life in years, or quality-adjusted life-years (QALYs).7 Compared with a decade ago, the price range of new anticancer agents has more than doubled, from

DNA topoisomerase II as a target of antineoplastic drug therapy

4,500 to more than

Protein-associated deoxyribonucleic acid strand breaks produced in mouse leukemia L1210 cells by ellipticine and 2-methyl-9-hydroxyellipticinium

10,000 per month.4,5 Of the 12 anticancer drugs approved by the US Food and Drug Administration (FDA) in 2012, only three prolonged survival, two of them by less than 2 months. Yet nine were priced at more than

The reconstitution of higher-order DNA structure after X-irradiation of mammalian cells.

10,000 per month. Many so-called targeted therapies have been priced between

The formation and resealing of intercalator-induced dna strand breaks in isolated l1210 cell nuclei.

6,000 to 12,000 per month, or approximately

DEFECTIVE MONOCYTE KILLING IN PATIENTS WITH MALIGNANCIES AND RESTORATION OF FUNCTION DURING CHEMOTHERAPY

70,000 to 115,000 per patient annually (Table 1).11 However, novel or reformulated chemotherapy drugs like pralatrexate (Folotyn; Allos Therapeutics, Westminster, CO;