But the DMCB digresses. Avastin is a biologically manufactured complex protein (an antibody) that binds to another protein that regulates the formation of new blood vessels. Many cancers are thought to grow in part due to their ability to create new “feeder” vessels, and this agent blocks that, causing tumor starvation. It’s typically not given as a single treatment, but as part of a “cocktail” with other drugs. It was originally approved by the U.S. Food and Drug Administration in February of 2004 when a prospective clinical trial involving metastatic colon cancer patients showed Avastin increased survival from 15.6 to 20.3 months. It’s since been approved by the FDA for most types of lung cancer and for metastatic breast cancer. Avastin is NOT approved by the FDA for treatment of brain cancer gliomas, but it is widely used ‘off-label’ for a variety of kinds of cancers.
Gliomas are one of those 'off label' cancers Research in one series of 23 patients with a recurrence of their cancer after standard treatment showed Avastin (plus another agent called irinotecan) led to 'six month progression free survival' rate of 46% and a 6 month survival of 77%. Other studies in 30-50 patients have shown similar results. This was enough to prompt the widely respected National Comprehensive Cancer Network to place Avastin in their approved guidelines as 'salvage' therapy for gliomas that have come back. Aetna will cover it for gliomas also.
Why is Avastin a source of such pain for health insurers? According to this analysis, the Medicare reimbursement for Avastin is about $57 per 10 mg. Recall gold is about $300 per oz. Avastin is over $160,000 per oz. A treatment course involving several doses over several months can cost up to $90,000. To get further perspective, note that the cost for Avastin is over $340,000 per year of life gained, and contrast it with this well written $129,000 article in Time. Yes, it's only money, but health insurers have a role assessing the real value of the services they cover on behalf of their enrollees.
Far be it from the DMCB to ‘price’ a living human being, but $90K is a lot of money for progression free or disease free survival that is typically measured in months. That’s true whether health insurers want to keep that money as a return on equity for their investors - or to make not-for-profit health insurance (where I worked) as affordable as possible.