As thousands of doctors, drug company execs, and investors arrive in Chicago this weekend for the American Society of Clinical Oncology meeting — the annual Woodstock of cancer research — a new report released on Thursday attempts to quantify the extent to which treatments and R&D are taking hold. And the numbers are impressive, although access remains an issue along with outstanding questions about value.
Consider the following: last year, annual global spending on cancer treatments and drugs used for supportive care hit $107 billion, up 11.5 percent from 2014, although this does not include manufacturer rebates. Of this total, $84 billion was spent specifically on cancer meds, which increased 14 percent from 2014, according to an analysis by the IMS Institute for Healthcare Informatics, the market research firm.
Such spending should not be surprising, given aging populations and, of course, the emergence of immunotherapies, which harness the immune system to thwart tumors. Medicines from Merck and Bristol-Myers Squibb, for instance, are being increasingly embraced for combating melanoma and a form of lung cancer.
Assuming existing and future immunotherapies are approved to treat eight potential ailments by 2020, Cowen analyst Boris Peaker projects global sales for immunotherapies reaching $30 billion, up from his previous estimate of $27 billion just seven months ago. Overall, IMS calculates that global oncology spending will reach $150 billion by 2020.
These bullish views also reflect bulging product pipelines. The number of oncology drugs in clinical development grew by more than 60 percent over the past decade. And the 10 largest oncology companies — which IMS defines as those measured by current sales of existing cancer drugs — have a total of 130 molecules in their late-stage pipelines.
Cost, however, is an issue. Globally, IMS finds that the annual growth in the cost of oncology drugs will range from 7.5 percent to 10.5 percent through 2020. In the United States, for instance, the cost of oncology drugs rose 72 percent, or $15.9 billion, over the past five years. The US, by the way, now accounts for 46 percent of the global market for oncology therapeutics, up from 39 percent in 2011.
Nearly half of that growth in global oncology spending can be attributed to higher prices in the US, along with the strengthening US dollar, IMS reports. By way of example, the market research points to increasing costs for cancer and supportive care medicines, which rose from 2 percent in 2011 to nearly 14 percent last year, at constant exchange rates.
Over $9 billion of total growth came from the availability of new therapies introduced since 2010, and IMS wrote that a similar amount was due to increased volume and pricing of existing branded drugs.
But here is a sobering nugget: over the past five years, 70 new oncology drugs were launched in developed countries for treating more than 20 different tumors. But most of the drugs are not yet available in most countries because they may not be reimbursed. For instance, only six countries — the US, Germany, the United Kingdom, Italy, France, and Canada — have access to more than half of the latest oncology drugs.
Of the drugs approved in 2014 and 2015, only the US, France, and Scotland have more than half included on reimbursement lists at the end of 2015, according to IMS.
“Most health systems are struggling to adapt and embrace this evolution” of immunotherapies, said Murray Aitken, who heads the IMS unit, in a statement.
Another issue is whether all of the treatments actually provide value.
Among 71 new drugs approved for solid tumors between 2002 and 2014, the median improvement in survival is 2.1 months, according to a study. Another analysis of 36 cancer meds approved between 2008 and 2012 on the basis of surrogate markers found some drugs lengthened the time after treatment before cancer worsened or tumors shrunk on scans. But only five boosted survival rates.
Some other tidbits from the report: Almost $5 billion was saved during the past five years when the loss of patent exclusivity for some older brand-name drugs prompted less use of those medicines and a switch to lower-cost generics.
The median time from patent filing in the US to approval for oncology drugs endorsed by the US Food and Drug Administration in 2015 was 9.5 years, down from 10.25 years in 2013.