Are Bexxar and Zevalin really held hostage by “market forces”?

The New York Times implies that cancer drugs Bexxar and Zevalin, which treat non-Hodgkin’s lymphoma, are being stymied by “market forces.” See Market Forces Cited in Lymphoma Drugs’ Disuse. The article shows stern photos of three patients who have been cancer-free after receiving one of the drugs and goes on to note that few patients receive the drugs relative to the potential market. The Times blames reimbursement policies that provide incentives for community-based oncologists to administer other drugs. (Reimbursement policies aren’t exactly my idea of “market forces” by the way.)
If you just look at the photos, read the headline and lead paragraph, you’ll be pretty mad –and also misled. To the Times’ credit, the same article presents a variety of compelling reasons why the drugs aren’t used more:

The drugs have not been clinically proven to prolong survival, compared with other therapies…

While Bexxar and Zevalin help many patients, only a minority become cancer-free for many years…

Because they are radioactive, they are almost always administered in hospitals, not doctors’ offices…

Doctors agree that Rituxan is an excellent drug with only minor side effects for most patients…

Prescribing Zevalin also requires oncologists to coordinate care with the hospitals that administer it. To get either Zevalin or Bexxar, patients first receive a low-radiation diagnostic dose, then imaging scans, then a high-radiation therapeutic dose, which comes a week after the first dose. Over the next weeks the patient’s red and white blood cell counts must be monitored.

The back-and-forth makes the treatment complicated to oversee, said Dr. Joseph M. Connors, a lymphoma specialist in Vancouver, British Columbia. “The doctors looking after people tend to turn to tools that they themselves know how to use and are familiar with,” he said.

So the story is a lot more complicated than it looks. And the Times is barking up the wrong tree by blaming market forces. The story is much more about lack of coordination of care among physicians and hospitals, plus the complexity of the supply chain for radioactive products.

These drugs are extremely difficult and costly to manufacture and distribute. The drugs have short half-lives, so the path from factory to patient has to be very well managed. You can be certain that the drugmakers aren’t making outsized profits on these drugs. The fact that they continue to supply them in light of their poor sales and high costs says more about the corporate responsibility of GlaxoSmithKline and Biogen Idec than anything else. If pure “market forces” were at work the products would probably be withdrawn.

As the Times reports, two clinical trials are underway to determine whether these drugs increase survival relative to Rituxan. The Times should revisit the topic once those results are in. If the drugs really are shown to be superior and still aren’t used, that’s a story.

July 16, 2007

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