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Figure 1.
Percent Change in Price of 86 Cancer Drugs Adjusted for Inflation by Drug
Percent Change in Price of 86 Cancer Drugs Adjusted for Inflation by Drug

Eighty-six cancer drugs reported average sales price in both January 2010 and January 2015. The following 11 drugs underwent price increases of 100% or more: carmustine, oral methotrexate, cyclophosphamide injection, oral cyclophosphamide, mitomycin, oral busulfan, leucovorin, vinblastine, oral etoposide, pegaspargase, and oral melphalan.

Figure 2.
Percent Change in Price of Cancer Drugs Adjusted for Inflation by FDA Approval Date
Percent Change in Price of Cancer Drugs Adjusted for Inflation by FDA Approval Date

FDA indicates US Food and Drug Administration.

1.
McCarthy  M.  Drug’s 5000% price rise puts spotlight on soaring US drug costs.  BMJ. 2015;351:h5114.PubMedGoogle ScholarCrossref
2.
Koons  C, Keller  M, Langreth  R. How EpiPen’s Price Rose. http://www.bloomberg.com/graphics/2016-epipen-pricing/. Accessed September 1, 2016.
3.
Hornberger  J.  Assigning value to medical algorithms: implications for personalized medicine.  Per Med. 2013;10(6):577-588.Google ScholarCrossref
4.
Centers for Medicare and Medicaid Services. Medicare Part B Drug Average Sales Price. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2015ASPFiles.html. Accessed September 1, 2016.
5.
Fojo  T, Grady  C.  How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question.  J Natl Cancer Inst. 2009;101(15):1044-1048.PubMedGoogle ScholarCrossref
6.
Experts in Chronic Myeloid Leukemia.  The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts.  Blood. 2013;121(22):4439-4442.PubMedGoogle ScholarCrossref
7.
Mailankody  S, Prasad  V.  Five years of cancer drug approvals: innovation, efficacy, and costs.  JAMA Oncol. 2015;1(4):539-540.PubMedGoogle ScholarCrossref
Research Letter
February 2017

The Rising Price of Cancer Drugs—A New Old Problem?

Author Affiliations
  • 1Knight Cancer Institute, Division of Hematology Oncology, Oregon Health & Science University, Portland
  • 2Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
  • 3Center for Health Care Ethics, Oregon Health & Science University, Portland
  • 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 5 Department of Pharmacy,Memorial Sloan-Kettering Cancer Center, New York, New York
  • 6Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
 

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Oncol. 2017;3(2):277-278. doi:10.1001/jamaoncol.2016.4275

The high price of older drugs has been increasingly criticized in part because of recent dramatic price hikes. Last August, Turing Pharmaceuticals increased the price of pyrimethamine from $13.50 to $750 per tablet—a 5000% increase—drawing widespread ire.1 More recently, the price of a 2-pack injectable epinephrine, EpiPen, was increased from $100 to more than $600.2 Raising the price of older drugs seems particularly objectionable when one considers that the outlay for research and development occurred long ago, and has almost certainly already been recouped,2 and it raises the question of how older drugs should be priced and valued.3

Whether and to what degree examples like pyrimethamine represent a common problem or exceptional cases remains unknown. Using Medicare data available for Part B, we sought to analyze the change in average sales price of cancer drugs between January 2010 and January 2015, and whether older drugs were more likely to undergo price increases than newer drugs.

Methods

We downloaded a list of Part B drugs and their Average Sales Price (ASP) from the Centers for Medicare & Medicaid Services website4 for the years 2010 and 2015, because we were concerned with trends over the past 5 years. We included any anticancer drug listed in both years for our analysis. All prices were inflation adjusted to 2015 US dollars. The percent change in inflation-adjusted price was compared from January 2015 to January 2010 for a fixed unit of the drug.

The date of first approval for each cancer drug was obtained from the US Food and Drug Administration’s (FDA) website. We prespecified that drugs would be dichotomized into old and new at the median date of approval. Our study was conducted on January 20, 2016. This study was based on previously published reports and did not analyze primary human data or samples and was therefore exempt from institutional review board approval. Statistical analysis was performed using R (version 3.2.2, R Project) and Stata statistical software (version 12.0, Stata Corp).

Results

Eighty-six cancer drugs reported average sales price in both January 2010 and January 2015. Adjusting for inflation, the change in price per unit of drug is shown in the waterfall plot in Figure 1. Thirty-one (36%) drugs decreased in price, and 55 (64%) drugs increased in price over this time period after adjusting for inflation. Eleven drugs (12.7%) underwent price increases of more than 100% (Figure 1).

The 43 drugs (50%) prespecified as older were approved from March 15, 1949, to November 18, 1992; and the 43 newer drugs (50%) were approved from December 29, 1992, to December 24, 2008. Older drugs increased in price more than newer drugs: median (interquartile range [IQR]) increase 22.7%, (−4.3% to 89.9%) vs 6.2% (−24.6% to 17.3%); P = .001. The continuous change in price by date of approval is shown in Figure 2, showing that older drugs undergo greater price increases than newer drugs (percent change in cancer drug price is 43% lower for each 10-year increase in FDA approval year; R2 = 0.14; P < .001).

Discussion

The high price of cancer drugs has increasingly drawn criticism from leading academic researchers, and threatens health care budgets.5,6 New drug pricing seems to bear no relationship to novelty or efficacy,7 or, in other words, drug prices are disconnected from the benefits provided. At the same time, price increases for older drugs have been less often discussed, but budgetary impacts can be quite large. For instance, although our investigation finds that the price of oral cyclophosphamide increased 300% after adjusting for inflation, absolute Medicare Part B spending on this drug increased from 1 million to 90 million dollars.4

Our analysis shows that older drugs have undergone larger price increases than newer drugs, and some drugs have undergone dramatic price increases. Our results suggest that solutions to the high price of cancer drugs must also consider the rising price of older drugs.

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Article Information

Corresponding Author: Sham Mailankody, MBBS, Myeloma Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1233 York Ave, New York, NY 10065 (mailanks@mskcc.org).

Published Online: October 6, 2016. doi:10.1001/jamaoncol.2016.4275

Author Contributions: Dr Mailankody had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Prasad, Mailankody.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Prasad, Mailankody.

Critical revision of the manuscript for important intellectual content: Prasad, Wang, Afifi.

Statistical analysis: Wang.

Administrative, technical, or material support: Mailankody.

Study supervision: Prasad, Mailankody.

Conflict of Interest Disclosures: None reported.

References
1.
McCarthy  M.  Drug’s 5000% price rise puts spotlight on soaring US drug costs.  BMJ. 2015;351:h5114.PubMedGoogle ScholarCrossref
2.
Koons  C, Keller  M, Langreth  R. How EpiPen’s Price Rose. http://www.bloomberg.com/graphics/2016-epipen-pricing/. Accessed September 1, 2016.
3.
Hornberger  J.  Assigning value to medical algorithms: implications for personalized medicine.  Per Med. 2013;10(6):577-588.Google ScholarCrossref
4.
Centers for Medicare and Medicaid Services. Medicare Part B Drug Average Sales Price. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/2015ASPFiles.html. Accessed September 1, 2016.
5.
Fojo  T, Grady  C.  How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question.  J Natl Cancer Inst. 2009;101(15):1044-1048.PubMedGoogle ScholarCrossref
6.
Experts in Chronic Myeloid Leukemia.  The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts.  Blood. 2013;121(22):4439-4442.PubMedGoogle ScholarCrossref
7.
Mailankody  S, Prasad  V.  Five years of cancer drug approvals: innovation, efficacy, and costs.  JAMA Oncol. 2015;1(4):539-540.PubMedGoogle ScholarCrossref
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