Costs of Cancer Treatment facing Patients and Societies Needs and - - PowerPoint PPT Presentation

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Costs of Cancer Treatment facing Patients and Societies Needs and - - PowerPoint PPT Presentation

Sep 25, 2023 137 likes •317 views

UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Costs of Cancer Treatment facing Patients and Societies Needs and Expectations Thomas Cerny Kantonsspital St.Gallen President Suiss Cancer Research Foundation KFS Past President Swiss

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Thomas Cerny Kantonsspital St.Gallen President Suiss Cancer Research Foundation KFS Past President Swiss Cancer League KLS thomas.cerny@kssg.ch

World Cancer Congress UICC Montreal / Canada, 27.-30.August 2012

Costs of Cancer Treatment facing Patients and Societies Needs and Expectations

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

SILENT PANDEMIC OF CANCER

  • Cancer is the world‘s leading cause of death followed by

heart disease and stroke

  • All Cancer Incidence will increase 2008-2030 from
  • 12.7 27 Mio (>70% Developing World)
  • Cancer leads to >7.5 Mio Deaths annually
  • Economic Loss close 1 Trillion US$/Y excluding direct costs

*Sullivan Lancet Oncology 2011

September 21, 2012

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Perception of Cancer in the Population

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§ Is the most deadly and insidious disease § Is the disease of modern time § Considered to be one disease § Is painful and disabling § Leads to social isolation § Is a punishment in some religions

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Declining Cancer Mortality Rate v Prevalence USA

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Rapidly Ageing Society in the Western World

Edwards BK, et al. Cancer. 2002;94:2766-2792.

3.0 2.5 2.0 1.5 1.0 0.5 Age (years) ≥85 75–84 65–74 50–64 <50 2030 2040 2050 2020 2000 2010 Year Cases of cancer (millions) few studies some studies most studies

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Orphan-Disease in Oncology

  • EU: „Rare-case-surveillance“
  • <6/100‘000 Incidence!
  • Only 16 „Common Cancers“ and
  • 194 „Rare Cancer Entities“

<10% in Focus of Drug-Development

  • www.rarecare.eu

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

September 21, 2012

Berggren Nature 2012 7

Number of Compounds in Clinicial Development

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Marked reached: Phase III Phase II Phase I SIRT

Nektar

NKTR-102

PEG-IRINOTECAN

Sanofi/ Regeneron

Aflibercept

(VEGF-TRAP)

BMS Brivanib

Keryx

Perifosine

Akt-Modulator

Bayer Sorafenib Novartis RAD001 Roche Pertuzumab Immatics IMA910 cancer vac.ine

Amgen AMG 102

HGF/c-Met receptor TK pathway

Amgen AMG479

anti IGF-1 receptor antibody

Novartis

EPO906 (epothilone B) AVEO Pharmaceutical AV-951

  • ral, triple VEGF receptor inh.

ArQule

ARQ 197

c-Met RTK

EMD Serono MSC1936369B MEK Inhibitor BMS-908662 RAF-Inhibitor

AstraZeneca

Cediranib (Recentin)

Abbott Laboratories

ABT-869

multitargeted TKI Amgen

AMG 386

selective angiopoietin 1 /2 neutralizing peptibody

Pfizer

Sunitinib Roche Bevacizumab Amgen Panitunumab Merck Cetuximab

Plexxicon/ Roche

PLX4032 Inhibitor

BMS

CT-322

VEGFR-2 Inh. Mikromet /Merck

adecatumumab

anti-EpCAM mAB

Pfizer

Axitinib

Ely Lilly

Enzastaurin

PKCß-selective inh.

Böhringer Ingelh.

VARGATEF

Triple-Angio. Inhib.

MSD

Dalotuzuma b IGF-1R

Taiho S1

Enzon

EZN-2 208

SN38 Prodrug Cytavis

CY-503

Apoptose-Ind. Centocor CNTO 328 anti IL-6 mAB Daiichi Sankyo

CS-70 17

PPARγ activator

Amgen

AMG 706

Multi-TKI

Astra Zeneca

ZD6474

VEGF & EGFR

Kyowa Hakko Kirin Pharma KRN330 mAB against A33

AVEO

Tivozanib

Triple VEGF Receptor Inhibitor Idera

IMO-2055

Toll-like Receptor 9 BRAF Immunomedics

Anti-CEA Bispecific Antibody

Radioimmunotherapy

YM BioSciences

Nimotuzuma b

Anti-EGFR-mAB AstraZeneca

Olaparib

PARP-Inh bei MSI-H

Bayer

Regorafeni b

Lilly

Ramucirumab

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Meropol, N. J. et al. J ClinOncol; 25:180-186 2007

Cost effectiveness of Colon Cancer treatment

K = 1000 US$

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Are targeted agents cost-effective?

Ocana A, Seruga B, Amir E, Kwong R,Tannock IF

21.09.12

I.Tannock, DGHO Basel 2011

  • We identified 25 new drugs approved by FDA for 17 malignant

diseases in 2000-2010, and estimated the cost per life-year gained

  • For only 37% of new agents was the cost per life-year gained

less than $100,000

  • The cost of new targeted agents needs to be reduced by a

median 78% to render them cost effective

  • We suggest registration of new anticancer drugs require

value-based pricing that renders them cost-effective

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

September 21, 2012

CRS 11(Congressional Research Service) 2000 on the Patent Ownership and R&D

  • n Bayh-Dole and Stevenson-Wyler-Act

§ „Disputes have arrisen over competing claims to IP

developed under government-industry ventures..

§ Concerns have been expressed regarding the right of

drug companies to set prices that were developed in part with federal fundig or in federal collaboration...

§ Problems have been encountered.....over diminished

effectiveness of IP if new applications are discovered“

§ Back to open access of all public funded research?

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Non Swiss Doctors in Swiss Hospitals

September 21, 2012

Anlass (über "Ansicht" - "Kopf und Fusszeile" zu ändern) 1 2

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

Direct Costs NCD per Patient of Disease Category

(Cancer UK/US: 5-5.6% Health Care Costs)

  • T. Cerny,

Sullivan R, Lancet 2011

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

September 21, 2012

ACS and Livestrong 2010

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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

September 21, 2012

Bray F, Lancet Oncol, 2012

Distribution of Wealth in 4 Categories of Global Human Development Index HDI HDI is an estimate by the UNDP 2007 of 3 dimensions:

  • 1. long and healthy life 2. knowledge 3. decent standard of living by GDP
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UICC Montreal 2012, Costs and Needs / Prof. T. Cerny

SUMMARY: COSTS AND EXPECTATIONS

  • Modern Oncology leads to more cure
  • Modern Oncology leads to

cure and better survival

  • Demograhics

and life style lead to a Cancer Tsunami

  • Most

new Oncology Drugs are not cost effective

  • Only

Very High HDI Countries can afford new drugs

  • New Drug Development is to

slow and not targeting our needs

  • Too

many false Incentives maximise/overuse medicine

  • Priorisation
  • f Prevention and Early Detection mandatory
  • IP: Privatisation
  • f Preclinical Reseach is not sustainable
  • The Oncology workforce is far

to small and migrates to VH-HDI

  • Access and Affordability
  • f Cancer Prevention and Care is a

realistic goal but needs ressources

September 21, 2012