Drug launches and DALYs
NEW YORK—While cancer remains one of the leading causes of death worldwide, deaths from cancer are on the decline. According to The Institute for Health Metrics and Evaluation, a survey of 188 countries found that between 1990 and 2013, “age-standardized death rates for all cancers fell in 126 out of 188 countries.”
The trend is an encouraging one, though unfortunately it's not a matter of cancer incidence rates dropping. The drop is due in part to more proactive preventative practices, both as public awareness of warning signs increase and as researchers identify biomarkers that allow for earlier diagnosis (and therefore treatment). It's also thanks to better cancer drugs—ones that are more targeted, more effective and with fewer or lessened toxic side effects.
Those improved drugs are the focus of a recent report from Columbia Business School. The research found that some 200 new cancer treatments have launched globally in the last 40 years, and the market value for such treatments continues to grow (partly because of the rising costs of drug development). Oncology therapeutics and supportive care cost $84 billion worldwide in 2010, and by 2015 that figure had risen to $107 billion—by 2020, the IMS Institute for Healthcare Informatics expects the total to rise to $150 billion.
The paper, “The Impact of New Drug Launches on Life-Years Lost in 2015 from 19 Types of Cancer in 36 Countries,” was released by the National Bureau of Economic Research earlier this year as part of its Working Paper series. Financial support came from Incyte Corporation and the National Institute on Aging, part of the National Institutes of Health.
The study, as explained in the abstract, “employs a two-way fixed effects research design to measure the mortality impact and cost-effectiveness of cancer drugs: it analyzes the correlation across 36 countries between relative mortality from 19 types of cancer in 2015 and the relative number of drugs previously launched in that country to treat that type of cancer, controlling for relative incidence.”
According to Dr. Frank Lichtenberg, author of the study and Courtney C. Brown Professor of Business at Columbia Business School, “What this study—and my larger body of research on pharmaceutical innovation—does is measure the significance of new cancer drugs over time and, particularly, how they have actually affected cancer mortality rates.”
As noted in the paper, “We estimate that drugs launched during the entire 1982-2010 period reduced the number of cancer DALYs [disability-adjusted life years] lost in 2015 by about 23 percent. In the absence of new drug launches during 1982-2010, there would have been 26.3 million additional DALYs lost in 2015.”
According to the World Health Organization (WHO), “One DALY can be thought of as one lost year of 'healthy' life.”
Of the 36 analyzed countries, Lichtenberg found that “In 2015, 76.6 million disability-adjusted life years [DALYs] were lost. Ninety-five percent of this loss was due to premature mortality, rather than to disability. The number of DALYs increased by 12 percent between 2005 and 2015. However, the number of patients diagnosed three years earlier increased by 28 percent. Therefore, the number of DALYs per patient diagnosed declined by 16 percent. The number of years of potential life lost before age 65 per patient diagnosed declined by even more: 25 percent.”
Lichtenberg's work found that for the most part, cancer drugs offer the most value—in the way of preventing deaths—five to 10 years after they launch, with the slow takeoff attributed to lower usage rates due to price, marketing and doctors adhering to more familiar drugs.
The report notes that the anti-cancer drugs that launched in the 2006 to 2010 period reduced the number of life-years lost due to cancer by approximately 8.7 percent in 2015. Lichtenberg estimates that without those drugs, there would have been 4.51 million additional years of life lost before age 75 in 2015, and 2.52 million additional years of life lost before age 65.
Given the increased number of anti-cancer drugs launched during 2011 to 2015 compared to 2006 to 2010, Lichtenberg says it's likely that there will be a 9.9-percent reduction in morality in 2020 from the drugs launched five to 10 years before.
This work examines the cost-effectiveness of cancer drugs as well. According to the report, “estimated expenditure in 2015 on drugs launched during 2006-2010 per life-year gained in 2015 ranged between $1635 to $2820—figures that the vast majority of health economists would define as highly cost-effective.” As per WHO, “In the field of health, a cost–effectiveness ratio usually represents the amount of additional health gained for each additional unit of resources spent.”
Lichtenberg writes in his report that “As noted by Bertram et al (2016), authors writing on behalf of the WHO’s Choosing Interventions that are Cost–Effective project (WHO-CHOICE) suggested in 2005 that “interventions that avert one DALY for less than average per capita income for a given country or region are considered very cost–effective; interventions that cost less than three times average per capita income per DALY averted are still considered cost–effective.” Population-weighted average per capita income (GDP) in the 36 countries in 2015 was $US 21,359, so these estimates indicate that the new drugs launched during 2006-2010 were very cost–effective, overall.”
“Cancer has become a huge focus of pharmaceutical innovation in recent years,” said Lichtenberg. “While we hear a lot about the cost of drugs, their actual value is less often discussed.”