There are two drugs used for prostate
treatments where potentially huge cost savings could be achieved. Such savings will work unfavorably for the
drug companies responsible for these medications in a financial sense.
The first drug is dutasteride. This has been shown to be useful in treating
lower urinary tract symptoms due to benign growth of the prostate gland. It is generally taken at a dose of 0.5mg
daily. What few people recognize is the
fact that the drug has a particularly long half life, or in other words, the
time that it takes for half of the drug to be cleared from the system. The terminal elimination half life of
dutasteride is approximately 5 weeks.
This does not mean that you could take one tablet every 5 weeks as it
needs to be taken often enough to achieve what we call a steady state level in
the blood stream. On a daily dose, about
90% men achieve a steady state level of the drug by 3 months. The data however, implies that we could
probably achieve adequate dosing of dutasteride at far less frequent dosing
intervals. The extent to which this is
possible needs to be determined with clinical trials and we could potentially
discover that dosing once a week or every two weeks might be more than
sufficient. One does not need to be a
rocket scientist to understand the potential savings for a commonly prescribed
drug for a hugely common condition. Do
not expect the drug company to support a study that has the potential to lead
to a 90% reduction or more in earnings for the drug. Will non-industry funding bodies support such
a study? Highly unlikely given the relative
non-sexy nature of the drug and condition it treats as well as the fact that
the cost is currently affordable to most individuals at around $30-35 per month.
The second drug is abiraterone. This is a breakthrough treatment for advanced
prostate cancer. Compared to any
chemotherapy agent for prostate cancer, it delivers substantial and clinically
meaningful effects on disease progression and prolongs survival. The thing that many people may not be aware
about is the fact that the bioavailability of the drug is significantly
enhanced by food. Data has been
collected on this with registered trial NCT01798628 (clinicaltrials.gov) that
was completed in 2009 but the results do not appear to have been published in
any journal on my attempt to find it on a Pubmed search. The drug is administered on an empty stomach in the form of four 250mg tablets.
It has been anecdotally suggested that the bioavailability can be
increased by anywhere between 5 to 17 fold by having the drug with a fatty meal
– it is incredibly difficult to find a study to actually cite for these figures
that are loosely verbally discussed at meetings. The argument against having the drug with
food is the inconsistency of absorption with a meal. Just what if we could control how much and
what food was administered at the same time?
There is clearly a potential for men to take one instead of four tablets
each day in order to derive the same benefit.
This would certainly work against the efforts of the drug company who
would stand to lose 75% of their income – the cost in Australia would fall from
around $3000 per month to $750 per month.
Fortunately, the University of Chicago are doing a study to look at this
very issue and as you would have guessed, it is being funded by the university
and the National Institute of Health (NCT01543776) and not by the pharmaceutical industry. This trial is currently in progress and the
results could lead to huge cost savings for men with advanced prostate cancer.
In summary, we have two drugs for which
there is the potential to deliver enormous cost savings. One is cheap but is used on a large scale
whilst the other is expensive and used on a smaller scale and it would not
surprise me if it could be proven that the cost savings with both would be
similar. It is certainly food for thought.
