I'm following up to the Provenge post I did a couple days ago. That was a summary of a Seeking alpha analysis of the issues Provenge would face in the reiombursement arena. The conclusion was that Provenge was very very expensive versus the ultimate benefit delivered - at least by standard methods for estimating QALY (quality of life year). The Seeking Alpha analysis concluded that be using even charitable assumptions in estimating QALY - best case would yield $282,000 per QALY. It noted that the UK's NHS rarely funded a QALY in excess of $60,000.
In the Pharmalot post above, US insurers indicate that Provenge likely will score a QALY in range of $300,000 under best case calculations. An unnamed participant in the analysis was quoted as saying "Provenge is an extremely expensive treatment and will probably be limited to as small a niche as possible. The price ($93,000 per patient) is not justified by the incremental survival (average 4 months)."
Most 3rd party payers will place restrictions on this drug's reimbursement, and up to 65% may restrict patient access. They all foresee its usage based strictly on the label.
Posted by Bruce Lehr July 9th 2010.