Are high drug prices for hematologic malignancies justified? A critical analysis

In the past 15 years, treatment outcomes for hematologic malignancies have improved substantially. However, drug prices have also increased drastically. This commentary examines the value of the treatment of hematologic malignancies at current prices in the United States through a reanalysis of a systematic review evaluating 29 studies of 9 treatments for 4 hematologic malignancies. Incremental cost-effectiveness ratios (ICERs) were calculated on the basis of drug prices in the United States in 2014. Sixty-three percent of the studies (15 of 24) had ICERs higher than $50,000 per quality-adjusted life-year (QALY), the benchmark widely used by health economists to define cost-effectiveness. In studies evaluating the current standard-of-care treatments for chronic myeloid leukemia, the ICERs for tyrosine kinase inhibitors versus hydroxyurea or interferon ranged from $210,000 to $426,000/QALY. The lower ICER values were mostly obtained from 11 studies evaluating rituximab, which was approved by the Food and Drug Administration in 1997 (ICER range, $37,000-$69,000/QALY). In conclusion, the costs of the majority of new treatments for hematologic cancers are too high to be deemed cost-effective in the United States.