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Paying a high price for cancer drugs
Editorial
Klaus Guldbrandsen/Science Photo Library
Time to introduce organ donation to the concept of precision?
For the Organ Donation and Transplantation Activity Report 2014/15 see http:// nhsbtmediaservices.blob.core. windows.net/organ-donationassets/pdfs/activity_ report_2014_15.pdf
Last week, the UK Organ Donation and Transplantation Activity Report for 2014/15 showed that the number of people receiving organ transplants in the UK decreased for the first time in more than a decade, prompting NHS Blood and Transplant to issue a plea for a national conversation about organ donation. This year’s activity breakdown highlighted the fact that the number of people who chose or were able to donate their organs in 2014 fell, and that 224 fewer people in the UK received an organ transplant than the year before. Two figures were singled out for attention. First, no appreciable rise has occured in the proportion of families who gave consent to organ retrieval following the death of a relative, which continues to hover “stubbornly below 60%”. This flatline is coupled to a sharp drop-off in the number of people who died in circumstances in which they were deemed eligible to donate their organs (8157 in 2013–14 vs 7450 in 2014–15), following straight on from a record-breaking 10% increase in transplant operations in the previous year.
In 2014, 6% of organ retrievals resulted in no transplants at all, compared with 4% in the previous year. So perhaps it is now time to reframe the debate away from changing belief systems around the gifting of our organs, towards the introduction of precision and rationalisation to the undoubtedly complex but occasionally haphazard, surgeon-level decision-making process that ultimately dictates the use and rejection of the tissues harvested from our recently departed loved ones. Although the number of used deceased donors was 18·8 per million population in 2014, the number authorised for organ retrieval was 29·9 per million people and there are still no nationally agreed age criteria for kidney and liver donation in the UK. As Rafael Matesanz, Director of Spain’s world-leading Organización Nacional de Trasplantes, recently reminded us, we should “…never blame the population. If people donate less, it must be something we have done wrong”. The Lancet
Astier/BSIP/Corbis
Paying a high price for cancer drugs
For the article on bisphosphonates see Lancet 2015; published online July 23. http://dx.doi. org/10.1016/S01406736(15)60908-4 For the Mayo Clinic Proceedings commentary see http://www. mayoclinicproceedings.org/ article/S0025-6196(15)004309/fulltext For the WHO Essential Medicines List see http://www.who.int/ medicines/publications/en
404
Results of research from the early Breast Cancer Triallists’ Collaborative Group in Oxford, UK, published in The Lancet on July 24, 2015, were encouraging. They showed that use of adjuvant bisphosphonates in the treatment of early breast cancer in postmenopausal women could reduce disease recurrence and mortality. Bisphosphonates, available in generic form, are inexpensive and should be available worldwide to improve care in this population. Just a day earlier, a commentary published in Mayo Clinic Proceedings was co-signed by 118 US cancer physicians, entitled “In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs”. The article sets out some sobering facts: the price of new cancer drugs in the USA has increased five-to-tenfold in the past 15 years; in 2014, all new US Food and Drug Administration (FDA)-approved cancer drugs were priced higher than US$120 000 per year of use; and recent trends in the medical insurance industry have pushed user contributions up to 20–30% of drug costs, despite the average annual US household income being around $52 000.
The Mayo Clinic Proceedings commentary also draws attention to ways in which the high pricing of cancer drugs could be challenged, including a fair pricing review process after FDA approval, which would allow Medicare to negotiate drug prices and to open up drug imports from neighbouring countries, notably Canada, where drug pricing is around half that of the USA. An online petition, seeking 1 million signatures to amplify concerns in a grass-roots campaign, is gathering momentum. WHO has recently added 16 new cancer drugs to its Essential Medicines List, including imatinib for the treatment of chronic myeloid leukaemia, which costs around $100 000 per year of use. WHO considers the core list to represent “the minimum medicine needs for a basic healthcare system”. It therefore seems depressingly clear that industry’s inflated pricing of new cancer drugs is contributing to a failure of health systems to offer promising new therapies to the very people for whom the drugs are created—cancer patients worldwide. The Lancet www.thelancet.com Vol 386 August 1, 2015
Klaus Guldbrandsen/Science Photo Library
Time to introduce organ donation to the concept of precision?
For the Organ Donation and Transplantation Activity Report 2014/15 see http:// nhsbtmediaservices.blob.core. windows.net/organ-donationassets/pdfs/activity_ report_2014_15.pdf
Last week, the UK Organ Donation and Transplantation Activity Report for 2014/15 showed that the number of people receiving organ transplants in the UK decreased for the first time in more than a decade, prompting NHS Blood and Transplant to issue a plea for a national conversation about organ donation. This year’s activity breakdown highlighted the fact that the number of people who chose or were able to donate their organs in 2014 fell, and that 224 fewer people in the UK received an organ transplant than the year before. Two figures were singled out for attention. First, no appreciable rise has occured in the proportion of families who gave consent to organ retrieval following the death of a relative, which continues to hover “stubbornly below 60%”. This flatline is coupled to a sharp drop-off in the number of people who died in circumstances in which they were deemed eligible to donate their organs (8157 in 2013–14 vs 7450 in 2014–15), following straight on from a record-breaking 10% increase in transplant operations in the previous year.
In 2014, 6% of organ retrievals resulted in no transplants at all, compared with 4% in the previous year. So perhaps it is now time to reframe the debate away from changing belief systems around the gifting of our organs, towards the introduction of precision and rationalisation to the undoubtedly complex but occasionally haphazard, surgeon-level decision-making process that ultimately dictates the use and rejection of the tissues harvested from our recently departed loved ones. Although the number of used deceased donors was 18·8 per million population in 2014, the number authorised for organ retrieval was 29·9 per million people and there are still no nationally agreed age criteria for kidney and liver donation in the UK. As Rafael Matesanz, Director of Spain’s world-leading Organización Nacional de Trasplantes, recently reminded us, we should “…never blame the population. If people donate less, it must be something we have done wrong”. The Lancet
Astier/BSIP/Corbis
Paying a high price for cancer drugs
For the article on bisphosphonates see Lancet 2015; published online July 23. http://dx.doi. org/10.1016/S01406736(15)60908-4 For the Mayo Clinic Proceedings commentary see http://www. mayoclinicproceedings.org/ article/S0025-6196(15)004309/fulltext For the WHO Essential Medicines List see http://www.who.int/ medicines/publications/en
404
Results of research from the early Breast Cancer Triallists’ Collaborative Group in Oxford, UK, published in The Lancet on July 24, 2015, were encouraging. They showed that use of adjuvant bisphosphonates in the treatment of early breast cancer in postmenopausal women could reduce disease recurrence and mortality. Bisphosphonates, available in generic form, are inexpensive and should be available worldwide to improve care in this population. Just a day earlier, a commentary published in Mayo Clinic Proceedings was co-signed by 118 US cancer physicians, entitled “In Support of a Patient-Driven Initiative and Petition to Lower the High Price of Cancer Drugs”. The article sets out some sobering facts: the price of new cancer drugs in the USA has increased five-to-tenfold in the past 15 years; in 2014, all new US Food and Drug Administration (FDA)-approved cancer drugs were priced higher than US$120 000 per year of use; and recent trends in the medical insurance industry have pushed user contributions up to 20–30% of drug costs, despite the average annual US household income being around $52 000.
The Mayo Clinic Proceedings commentary also draws attention to ways in which the high pricing of cancer drugs could be challenged, including a fair pricing review process after FDA approval, which would allow Medicare to negotiate drug prices and to open up drug imports from neighbouring countries, notably Canada, where drug pricing is around half that of the USA. An online petition, seeking 1 million signatures to amplify concerns in a grass-roots campaign, is gathering momentum. WHO has recently added 16 new cancer drugs to its Essential Medicines List, including imatinib for the treatment of chronic myeloid leukaemia, which costs around $100 000 per year of use. WHO considers the core list to represent “the minimum medicine needs for a basic healthcare system”. It therefore seems depressingly clear that industry’s inflated pricing of new cancer drugs is contributing to a failure of health systems to offer promising new therapies to the very people for whom the drugs are created—cancer patients worldwide. The Lancet www.thelancet.com Vol 386 August 1, 2015