IF A patient came to an oncologist with advanced breast cancer, the doctor might well prescribe Avastin, even though the drug doesn't significantly prolong life and costs $92,000 a year. In combination with the drug Taxol, Avastin will shrink the tumor, and for a few months may make her feel more like herself, with less pain and nausea.
A justifiable medical decision, however, may not constitute sound health policy. The debate over Avastin starkly illustrates the tension between making advanced drugs widely available and making healthcare coverage affordable to all.
The Food and Drug Administration decided a few days ago that Avastin could be used to treat breast cancer even though it was originally developed to treat cancer of the colon. The FDA overruled an advisory committee that thought the side effects - high blood pressure and bleeding - were too risky and the benefits too questionable to designate Avastin for breast cancer treatment.
In Massachusetts the FDA decision was not an issue. A 1990s state law requires health insurers to pay for any officially recognized anticancer drug, even if it was approved for another form of the disease. Some oncologists have been prescribing Avastin for years. The Legislature, when it approved this law, did not take cost into account.
After the FDA announced its decision Feb. 28, the stock of
Yet $92,000 spent on extending healthcare coverage is likely to save more lives than a year of Avastin will. Those with good insurance are more likely to be screened for cancer regularly. A few days before the FDA decision, the American Cancer Society reported on a study that, unsurprisingly, found that people without health insurance were diagnosed with advanced cancer more often than those with comprehensive private coverage.
Breast cancer patients featured prominently in the study. Those who were diagnosed late probably either couldn't afford a mammogram ($200 to $300), or weren't seeing a doctor who would push them to get one. The government should be encouraging every American woman over 40 to get one.
Genentech has announced a program that would cap the yearly per-patient cost of Avastin at $55,000 in households earning $75,000 or less. Avastin will be used more as the price goes down, and eventually might be proven to extend life as well as shrink breast cancer tumors. Whatever the value of an individual drug, the profit-induced emphasis on high-tech medicine is a misdirected priority.
Both Genentech and the FDA are cogs in a system in which the financial incentives are wrongly skewed. A wise national health policy would put prevention ahead of a non-cure.
