The high price of anticancer drugs: origins, implications, barriers, solutions

Abstract

Globally, annual spending on anticancer drugs is around US$100 billion, and is predicted to rise to $150 billion by 2020. In the USA, a novel anticancer drug routinely costs more than $100,000 per year of treatment. When adjusted for per capita spending power, however, drugs are most unaffordable in economically developing nations, such as India and China. Not only are launch prices high and rising, but individual drug prices are often escalated during exclusivity periods. High drug prices harm patients — often directly through increased out-of-pocket expenses, which reduce levels of patient compliance and lead to unfavourable outcomes — and harms society — by imposing cumulative price burdens that are unsustainable. Moreover, high drug prices are not readily explained by rational factors, including the extent of benefit patients are likely to derive, the novelty of the agents, or spending on research and development. Herein, we summarize the available empirical evidence on the costs of anticancer drugs, probe the origins and implications of these high costs, and discuss proposed solutions.

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Figure 1: Cost of one month of treatment with the top 10 bestselling anticancer drugs in the USA10 and Norway130.
Figure 2: Median monthly launch price of a new anticancer drug, compared with median monthly household income from 1975–2014 in the USA.
Figure 3
Figure 4: Spending on hospital care versus spending on prescription drugs.

Change history

  • 03 April 2017

    The originally published article contained a misrepresentation of the dose of pembrolizumab that most patients receive. "Consider, as an example, the anti-programmed cell death protein 1 (PD-1) antibody pembrolizumab, a novel immunotherapeutic drug, for which administration to treat one person for 1 year (at a dose of 10 mg/kg) can now cost in excess of $1 million11" has been corrected to "For a 75 kg patient, the initially approved dose of 2 mg/kg every 3 weeks would cost approximately $121,000 per patient per year. That price goes to approximately $161,339 at the more recently FDA-approved 200 mg flat dose every 3 weeks, and at a dose of 10 mg/kg every 2 weeks, a dose not approved at the time of this writing but used in multiple published trials11–13, the cost for a 75 kg patient would be almost $1 million per year14." References to the trials that use the 10 mg/kg dose have been added and the other references updated throughout. These changes have been made in the online, PDF and print versions of this manuscript.

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All authors made a substantial contribution to researching data for this article, discussions of content, writing the manuscript and reviewing and/or editing the manuscript before submission.

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Correspondence to Sham Mailankody.

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Prasad, V., De Jesús, K. & Mailankody, S. The high price of anticancer drugs: origins, implications, barriers, solutions. Nat Rev Clin Oncol 14, 381–390 (2017). https://doi.org/10.1038/nrclinonc.2017.31

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