Economic Times, November 26, 2015. Mumbai: As insurers, patients and governments across the world debate over the rising cost of healthcare, Swiss pharmaceutical major Roche has boldly launched two new drugs for late-stage breast cancer, pricing them higher than any other cancer medicine in the Indian market.
Kadcyla and Perjeta, the new class of drugs launched in India in October, cost Rs 2,10,000 (200 ml) and Rs 2,49,000 for a dosage, respectively. ET verified the price with several chemists and doctors, who said the maximum discount that was available was in the range of Rs 10,000-15,000. Roche said it gives the drugs free of cost after an initial stage of treatment.
Breast cancer is the leading cause of cancer death among Indian women. Nearly 1.3 lakh women are diagnosed every year with the disease in India. Kadcyla and Perjeta are prescribed for breast cancer patients tested positive for the HER2 protein, which promotes the growth of cancer cells.
These drugs are given when the cancer becomes metastatic, or in simple terms when the tumour spreads to other parts of the body where the chances of cure are negligible. They are recommended when patients fail to respond to Herceptin (trastuzumab), the most commonly prescribed treatment for breast cancer.
The cost of the drugs over a nine-month period hovers around Rs 12 lakh for Kadcyla and Rs 30 lakh for Perjeta. In India, Roche collaborated with Pune-based Emcure Pharmaceuticals to sell Herceptin under a local brand name, Herclon, which costs about Rs 65,000 a vial.
Responding to ET’s questions, Roche said it has a patient assistance programme aimed at lowering the cost of treatment. “We at Roche believe that access programmes need to be sustainable in order to have a long-lasting impact,” the company said in an email response. “Our patient-assistance programme for Perjeta and Kadcyla is designed such that patients only have to pay for finite cycles of therapy and hence the total cost is significantly lowered,” a Roche spokesperson said in an email response to ET.
Incidentally, last week, the National Institute of Health Care and Excellence (NICE), an agency that is involved in guiding healthcare improvement, has advised UK’s National Health Service against including Kadcyla in its reimbursement scheme citing a mismatch between price and value.
The Indian government itself has taken note of high-priced cancer drugs and signalled controls over those. More recently, Union Health Minister JP Nadda unveiled the first outlet to supply low-cost cancer drugs at the All India Institute of Medical Sciences in New Delhi. Oncologists in India expressed their concerns over the high price tag that these drugs came attached with.
“These newer drugs are prescribed after Herceptin fails. Any failure has no cure. So I have to tell the patients that you might be getting three months of extra life for spending Rs 20 lakh,” said Dr Rajendra Badwe, surgical oncologist at Mumbai’s Tata Memorial Cancer Hospital (TMC). “It is a value judgement that needs to be done, and the care giver is put into a big dilemma of decision-making.”
A leading oncologist from a public hospital in south India said he has not encouraged patients to get on these drugs because of the price. “My patients here cannot even afford Herceptin, so we have made it clear to the patients about the price and the results that these drugs deliver,” said this oncologist who spoke on the condition of anonymity.
Kadcyla and Perjeta were approved by the US health regulator in 2013, after trial results suggested an increased rate of survival in late-stage patients compared with existing line of therapy. “In case of Kadcyla, it was found in studies that the patients’ average survival rate was 31 months compared to 25 months on the single Tykerb-based treatment (another drug used to treat breast cancer). For Perjeta, the survival rate was 56 months versus 40 months seen with only Herceptin and chemotherapy-based treatment,” said Dr Sudeep Gupta of TMC. “If patients can afford, we recommend this drug.”
Since Herceptin is witnessing local competition, experts said Roche may be looking to switch focus to the two new products. The company over the last two years has cut down the price of Herceptin, after Biocon and partner Mylan entered the market with their own biosimilar versions. In 2014, Kadcyla and Perjeta were significant contributors to Roche’s revenues, with both posting average sales of $500 million globally.
In the past, drug companies have tried new approaches to create better pricing points to make expensive medicines affordable to different levels of income groups. Two years ago, for instance, Japanese firm Eisai launched its breast cancer brand Halaven under a tiered pricing strategy tailored for the Indian market.