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 Cancer League KLS thomas.cerny@kssg.ch World Cancer Congress UICC Montreal / Canada, 27.-30.August 2012
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
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Perception of Cancer in the Population § 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 3
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Declining Cancer Mortality Rate v Prevalence USA
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Rapidly Ageing Society in the Western World 3.0 2.5 ≥ 85 Cases of cancer few studies 2.0 (millions) 75–84 Age (years) 1.5 some 65–74 studies 1.0 most 50–64 0.5 studies <50 0 2000 2010 2020 2030 2040 2050 Year Edwards BK, et al. Cancer . 2002;94:2766-2792 .
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 6
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Number of Compounds in Clinicial Development Berggren Nature 2012 September 21, 2012 7
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Roche Merck Amgen Bevacizumab Cetuximab Panitunumab Marked reached: Sanofi/ AstraZeneca Bayer SIRT Taiho BMS Regeneron Cediranib ( Recentin ) Regorafeni Phase III S1 Brivanib Aflibercept Keryx b Nektar (VEGF-TRAP) Perifosine Astra Zeneca NKTR-102 Böhringer Ingelh. ZD6474 Akt-Modulator Phase II VARGATEF PEG-IRINOTECAN YM BioSciences VEGF & EGFR Nimotuzuma Triple-Angio. Inhib. Amgen Kyowa Hakko Kirin Pharma Mikromet /Merck Ely Lilly b AMG 706 KRN330 Enzastaurin adecatumumab Roche Novartis Anti-EGFR-mAB Multi-TKI mAB against A33 PKCß-selective inh. EPO906 (epothilone B) Pertuzumab anti-EpCAM mAB Lilly Pfizer Ramucirumab Pfizer Axitinib AVEO Pharmaceutical Sunitinib Cytavis AV-951 Centocor BMS Abbott CY-503 CNTO 328 MSD CT-322 Laboratories oral, triple VEGF receptor inh. anti IL-6 Apoptose-Ind. Dalotuzuma ABT-869 VEGFR-2 Inh. mAB Enzon b AstraZeneca Daiichi Amgen Bayer multitargeted TKI EZN-2 IGF-1R Sankyo AMG 386 Olaparib Novartis Immatics Sorafenib CS-70 208 selective angiopoietin 1 /2 PARP-Inh bei RAD001 IMA910 cancer vac.ine neutralizing peptibody SN38 17 MSI-H Prodrug BMS-908662 PPAR γ Amgen Amgen EMD Serono activator RAF-Inhibitor Phase I AMG479 AMG 102 MSC1936369B anti IGF-1 receptor antibody HGF/c-Met receptor TK pathway MEK Inhibitor Plexxicon/ Idera ArQule AVEO Roche Immunomedics IMO-2055 ARQ 197 Tivozanib Anti-CEA Bispecific Antibody PLX4032 Toll-like Receptor 9 BRAF c-Met RTK Triple VEGF Receptor Inhibitor Radioimmunotherapy Inhibitor
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Cost effectiveness of Colon Cancer treatment K = 1000 US$ Meropol, N. J. et al. J ClinOncol; 25:180-186 2007
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Are targeted agents cost-effective? Ocana A, Seruga B, Amir E, Kwong R,Tannock IF • 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 I.Tannock, DGHO Basel 2011 21.09.12
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny CRS 11(Congressional Research Service) 2000 on the Patent Ownership and R&D on 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? September 21, 2012
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 1 ändern) 2
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) Sullivan R, Lancet 2011 T. Cerny,
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny ACS and Livestrong 2010 September 21, 2012
UICC Montreal 2012, Costs and Needs / Prof. T. Cerny Distribution of Wealth in 4 Categories of Global Human Development Index HDI Bray F, Lancet Oncol, 2012 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 September 21, 2012
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 • Most and life style lead to a Cancer Tsunami • Only new Oncology Drugs are not cost effective • New Drug Development is to Very High HDI Countries can afford new drugs • Too slow and not targeting our needs • Priorisation many false Incentives maximise/overuse medicine • IP: Privatisation of Prevention and Early Detection mandatory • The Oncology workforce is far of Preclinical Reseach is not sustainable • Access and Affordability to small and migrates to VH-HDI realistic goal but needs ressources of Cancer Prevention and Care is a September 21, 2012
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