The debate over the extent to which doctors will embrace the Provenge prostate cancer vaccine shows no sign of abating. Last week, a survey found most insurers believe usage will remain flat over the next several months (see here). Now, another survey indicates most docs believe the survival benefit must be longer than shown in studies and financial concerns are also a factor.
Specifically, 68 percent of 101 oncologists and urologists queried believe, that in order to prescribe Provenge or a similar life-extending treatment, the survival benefit must be seven months or more. And more than 30 percent say a medication needs to add at least one year of life, according to Sermo, the web site where docs like to dish (see this). The median survival benefit offered by the Dendreon vaccine, which costs $93,000, is 4.1 months.
And although chemotherapy can also be very expensive, which is a point made repeatedly by those who believe Provenge is worth the cost, 86 percent of the physicians believe that Provenge and other life-extending meds should not run more than $60,000. In fact, 57 percent believe the price of such meds should be less than $30,000. And 19 percent cite $10,000.
Meanwhile, 68 percent say they do not believe they will be reimbursed if they have to purchase Provenge in advance of reimbursement. Earlier this month, Dendreon execs shocked investors by lowering sales forecasts and citing concerns that many docs, particularly those in smaller settings, were slow to adopt the vaccine over reimbursement (read this).
One doctor recently told us that he paid $31,000 for each infusion and Provenge requires a three-dose administration look here). Consequently, physicians fear that a large loss even if they fail to receive reimbursement for just one patient. Medicare has done a good job with reimbursement, but other insurers have not done the same, Philip Kantoff of the Dana Farber Cancer Institute, tells BioPharm Insight, a market research firm.
Reimbursement has been a heated issue. Some private payers have require special authorization for coverage. But as Dendreon boosters have noted, the coding from the Centers for Medicare & Medicaid Services that went into effect on July 1 should cover claims and payment, and they argue that reimbursement concerns may reflect worries over delayed payment more than outright rejection.
"There appear to be three barriers to adoption," Sermo ceo Daniel Palestrant tells us. "The first is provider education and familiarity with the treatment. The second one we’ve identified appears to be directly related to the novel nature of the treatment itself. And the third is billing...Do physicians understand this? My belief based on the data and experience with such matters is no. In general, there is a remarkable lack of understanding of the billing process and technologies among physicians."
In any event, the survey also yielded these findings: 41 percent of the specialists gree or strongly agree that the method used to administer Provenge and related training would deter them from adopting the vaccine or similar treatments. Meanwhile, 68 percent of the docs surveyed also say the co-pay is a major concern for their patients
Separately, the likelihood that an assay will be developed for Provenge appears uncertain, due to the entrance of newer prostate cancer drugs on the market such as Johnson & Johnson’s, which Zytiga costs about $5,000 a month for a median treatment cycle of eight months, according to BioPharm Insight, which canvassed several specialists (read here).
The Zytiga labeling requires a patient to be on chemotherapy, while Provenge is given a few weeks before or after chemotherapy, the reseach firms notes, adding that the two drugs can be used in combination. Provenge, by the way, must be given three to six months prior to Zytiga due to its impact on the immune system. Zytiga, meanwhile, is also being evaluated in a Phase III trial with patients who have yet to receive chemotherapy, with results likely next year, BioPharm notes.