The cost of expensive breast cancer drugs

Background Increasing healthcare costs are a major challenge in medical oncology, since the total costs of oncology can account for up to 30% of the total hospital expenditures. As many novel (expensive) cancer treatments are being developed, it is important to be transparent about drug prices from an early research stage on. To assess the potential financial impact of pipeline drugs, their expected future prices can be deducted from prices of currently used drugs. As an overview of the standard prices of expensive breast cancer treatments in European countries is lacking, this review aimed to synthesize all evidence on costs of approved, expensive breast cancer drugs in the Netherlands. Methods A literature review was performed to create an overview of all approved, expensive drugs in the Netherlands. Standard drug costs were retrieved via the Dutch administrative health authority (ZINL). Drugs were considered expensive if the standard price of the drug was more than €10 per unit or if the cost of a treatment with that particular drug exceeded €1000 on average per patient. Results In the Netherlands 25 breast cancer drugs are approved with a standard price of more than €10 per unit. After excluding drugs with expected treatment costs less than €1000, 19 drugs were included in the analysis. The standard drug price is €7,943 on average (range €63 - €45,452), and the average number of cycles per patient is 10.5 (range 4 - 25.3 cycles). This results in average treatment costs per patient of expensive drugs of €17,968 (range €1,103 - €87,123). Four drugs that initially ranked low based on standard drug unit prices (rank 10-19), rank substantially higher (rank 1-10) when ranking total treatment costs. Conclusions Ranking standard drug prices per unit may not be very informative. It would be valuable to rank drug treatment costs, based on treatment length and dosage estimates. However, in the Netherlands the expected treatment length for a particular drug is not standardly reported in official approval reports. Furthermore, actual prices of expensive drugs may differ from standard drug prices, by which treatment costs might be deviant. Extending standardization of reporting and calculation of drug treatment costs would be valuable and particularly relevant when extending this type of cost calculations to other countries.