I thought this article was an interesting read, as discussions of "value" seem few and far between when it comes to healthcare. It never really occurred to me that dosing levels could be this controversial...
"Mark Ratain, an oncologist and pharmacologist at the University of Chicago, teamed up with Russell Szmulewitz, an oncologist and professor of medicine at the University of Chicago, to conduct a small study of a drug for metastatic prostate cancer called abiraterone, which was approved by the FDA in 2011. Abiraterone prescriptions require fasting, and food increases its concentration by 5- to 10-fold or more. In a trial of 72 patients published in 2018, Ratain and Szmulewitz showed that a quarter of the recommended dose taken with a low-fat breakfast was as effective as the full dose in delaying the disease from progressing.
The lower dose would also slash cost. The full dose of the brand version is more than $9,000 per month, and a generic introduced in 2018 costs about $3,000 per month or less — following the study’s lowered dosing would save the health care system thousands of dollars per month per patient.
A small controversy erupted over the study’s design and whether the results were significant enough to change clinical practice. Nevertheless, Ratain scored a small victory in 2019: The National Comprehensive Cancer Network — a non-profit alliance of 30 U.S. cancer centers that issues evidence-based treatment guidelines — now includes low-dose abiraterone with food as an alternative treatment option. The guidelines note that reduced costs could help save families from financial ruin and discourage patients from skipping doses to save money."
Written by
noahware
To view profiles and participate in discussions please or .
It's easy to think in a bubble if you can afford the meds. The reality is that taxes increase and people without the financial means might end up dying earlier simply because they can't afford the meds.
As an old guy on Medicare with PCa, I’ve found that it is easy to forget the days before I was sixty-five and became eligible for Medicare. I was paying $1200/mo for health insurance with a $10K annual deductible. How frightening it has to be to get diagnosed with PCa for my friends who are not yet insured by Medicare with a comprehensive drug plan that pays for the PCa meds and treatments.
Thanks for calling our attention to this article. IMO, major healthcare reforms that make coverage affordable for everyone are not coming fast enough.
Just think if the Zytiga studies would have measured lower doses. How do we know if 500 mg would work the same as 1000mg with maybe less side effects? I have been on 750 mg for 2 years and wonder if I could be on 500mg. As to eating with 250mg, how do you assure everyone is having the same meal, i.e. what exactly is a "low fat breakfast"?
Waiting for study of xtandi reduced dosage. I'm on half dose and PSA floating around 0.12 for last couple of years. WAY LESS side effects then full dose, I'm alive with a life worth living..
I certainly agree with your first three sentences. But I don't understand your last sentence. For example, assuming that you agree that it's appropriate for you to have patent protection if you've spent many millions to develop a widget, how does that fit in with negotiating price like most vendors in a free market?
I understand. They found that a 1000mg dose was tolerated. So that's what they tested. They could have also done a trial with 500 mg and/or 750 mg. I'll bet there would be less liver toxicity. But at 500 mg profits are cut in half. Call my cynical.
Nice historical look back at 10+ years ago. Makes you realize how much went into getting to today. But to me it just appears that as soon as 500 was safe, the 250 group moved up. Same with the 500 group moving up. I am amazed at the small number of people starting in each group. Thanks for the link. But yeah, still cynical.
I started it this month, blood work this week and appointment next week to check on the effectiveness and liver check, also getting first shot of xgeva. Take full dose 1 hour before eating breakfast then prednisone with breakfast, no side effects other than the intense hot flashes that I am used to. My co-pay is 163 dollars a month, not bad to handle, AARP united healthcare.
I started Firmagon on July 14, 2020. My oncologist then added abi 250 mg and pred 5 mg on Aug, 11. My breakfasts have been, for 5 years, fruit juice, a bowl of oatmeal, and a cup of tea. On weekends I have 2 eggs-fried, scrambled or poached, and a couple of slices of toast, with a bit of jelly or butter, juice, and tea. I take my meds right after breakfast, with my juice. My PSA dropped to .16 on Sept 30, and to <0.04 on Oct 27. Also, on Oct 27, my T was <7.0. A previous T measurement was 616.5 on Sept 3, 2015. Everything seems to be working. Only side effect so far is minor occasional hot flashes. I pay $85/month for the abi, and almost nothing for the pred.
Thanks for sharing, Dr. Szmulewitz is my oncologist and I’ve been on the 250mg Abiraterone together with 5mg Prednisone for over a year now, I take it with a light low fat meal. My PSA dropped to under 1 after spiking to 11 post prostatectomy. I am happy that with my insurance I only pay 70 per month for the drugs.
If everyone responded to the combination of breakfast and Zytiga with the same results it would be great. But to ensure this is what happens would require a good study.
Please show how it is a false assertion that the cost of manufacturing is a miniscule part of what is charged for these drugs, by giving us a reasonable estimate of that cost, relative to full retail pricing of new non-generics. The mere fact that it "ain't cheap" is not really useful in this respect, since it does not tell us if the expensive process is then followed by a 10x markup or a 1000x markup.
"He clearly implies that the manufacturing of meds is negligible"
First of all, he does not: he implies, no more than what he states, that the cost is low RELATIVE to prices charged.
Second of all, you said the assertion itself is false, not whatever that statement may or may not imply. If you know it to be false on account of your experience in drug manufacturing then why can't you give us some numbers?
Believe it or not, everybody with or WITHOUT any experience already knows that some of the cost is tied to raw materials, some tied to complexity of the manufacturing process, some tied to labor and infrastructure, etc. It is not a question of whether there are ANY costs to manufacturing.
Consider this quote:
"In 2016, branded imatinib cost $146,000 per year, while the generic version was priced at $140,000. In Canada, the patented product cost $38,000, whereas the generic was priced between $5000 to $8000; the generic in India runs about $400."
With coupons, one in the US can probably now get a year's worth for under $3k. Do you think the difference between $146k and $3k is due primarily to some sort of reduction in the costs associated with manufacturing?
It was reported in 2015 that:
"British researchers say the price of five common cancer drugs is more than 600 times higher than they cost to make. For instance, the analysis figures the true cost of a year’s supply of imatinib at $159."
That makes that drug's top retail about 1000x its cost to manufacture.
You seem like a decent fellow as well. I understand the argument being made, but I'm sure its hotly disputed. I don't know whether you actually have prostate cancer, but if you do, are you satisfied with the system as is? You don't try to find alternatives that might supplement or substitute for conventional treatment?
He used the word miniscule RELATIVE to price, in reference to the cost of manufacturing. If you don't think 1/1000 is miniscule, you are welcome to hold that opinion... all by yourself.
The LOL is that you think cancer normally moves from NON-metastatic to metastatic in a matter of months, depending on the immediate initiation of treatment. Your view is certainly NOT legit if you consider all the science that points to the long life cycle of PC and the slow development of the metastatic process, that is normally years and even decades in the making.
If you want to argue that I treated myself into advanced PC by not having a PSA test in the prior decade, before 2019, then THAT would be legit. But with a PSA of 26, the standard assumption should be that one already HAS mets, which was my assumption even before the biopsy. The 3+4 Gleason was a good suggestion that I had plenty of time to research the variations on hormonal therapy, as I had already decided RP is not nearly as "curative" as claimed (thanks to the books of urologist Anthony Horan).
BTW, I did drop my PSA in half with that diet. Do you think maybe a 50% drop in PSA somehow led to a near-instant metastisizing of non-metastaic cancer?
"had a positive DRE and > 20 psa ...that alone told you there was an issue"
I had a positive DRE and > 20 psa AND a 3+4 biopsy, all in a matter of days, so of COURSE "that alone" was an issue. But there is only one reason to get scans, in my opinion, and that is that they are going to be followed by a specific action depending on what they show. Since I had not decided on what course of action I preferred, regardless of what the scans showed, there was no good reason to get them immediately. If I was about to drop dead of bone mets, I'd probably get some signs of that.
PC is normally a very slowly progressing disease. And in case you haven't heard, metastatic cancer is NOT curable. It has always been accepted practice, if not once a preferred standard of care, to treat the symptoms of PC mets once they arise, and not necessarily before. The original point of castration and hormonal therapy was palliative, not curative. There are still many docs that argue hormonal therapy often simply buys you time, and that the overall amount of time it buys you does not necessarily change significantly if you start a bit sooner or a bit later. You are welcome to disagree with those doctors (that know a lot more about the disease than you).
You know what your belief is, that immediate treatment always prevents a worse outcome in everyone? Conjecture.
The keto diet is a proven means to lose weight. In case you didn't know (and you don't seem to know much), being 40 pounds overweight, pre-diabetic and having high levels of diet-related inflammation are thought by some (but apparently not you) to potentially accelerate cancer progression.
Plenty of men take steps on their own to address their poor health habits upon a discovery of illness. Some think it might make subsequent treatment more effective. You obviously think this is a bad idea. Enjoy your Twinkies and Coke.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Zytiga 
Workable strategies for obtaining low-cost ZYTIGA (abiraterone) from outside the US. 
Stage 4 , Veterans Administration
