Saturday, June 1, 2013
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.