Why Provenge Proves Everything Wrong With Medicare




On Monday, we talked about Dendreon's (DNDN) $93,000 Provenge treatment, which will now be covered by Medicare, a huge win for the company. But is it a huge loss for everyone else?

Beating Buffett says what everyone is thinking but no one wants to say:

Nobody wants to be the decision maker condemning a terminal patient to death a few months earlier than might be possible. What’s ignored, though, is that funds for treatment for the entire population are finite. If these near-death patients gain up to four months of poor quality of life it comes at the expense of denying billions of dollars of other, more routine care to younger, other beneficiaries that have real long-term prospects for productive lives.

There is no free lunch. Keeping someone alive for an extra 120 days could end up depriving thousands of people their basic health care needs. That our system is designed to prevent any cost/benefit analysis is absurd and ultimately dangerous to the health of the majority of Americans.

If the patients actually receiving this drug were asked to pay out their own pockets (and could afford it) I doubt that they would choose to spend the money that way as opposed to leaving it to their remaining family members. It’s always easy, though, to demand that somebody else pay for any and all treatments you desire and have available regardless of cost.

How do you value four months of someone's life?

Karl Denninger seems to feel this is the very root of our economic malaise, writing:

We cannot have a sustainable medical system in this country so long as the standard for whether you're entitled to some sort of treatment is simply "will it provide any benefit whatsoever irrespective of cost." Dendreon's (DNDN) Provenge is just one of thousands of examples. There are many conditions that are, within medical certainty, a death sentence. Metastatic prostate cancer is one of them. Most pancreatic cancers are another. The fact of the matter is that we can write checks with our medical technology that we cannot cash with our economy. There are two ways to ration any product or service: By price, and by political fiat. We choose to do neither and instead force the cost on others. This practice is bankrupting the country.

Dendreon knew it could price Provenge as high as they wanted, Medicare rules forbid negotiation on prices. So before you go whining about me being a heartless asshole, let's be real about it: maybe if Medicare actually worked logically, I'd have more sympathy for saving it.

Again: $93,000!

Jr Deputy Accountant

Some say he’s half man half fish, others say he’s more of a seventy/thirty split. Either way he’s a fishy bastard.

51 comments:

rjfs1716 said...

Seriously.... The answer is simple (IF YOU DONT WANT IT!!! DONT TAKE IT!!!) MEDICARE/ MEDICAID CAN't BASE COVERAGE ON PRICE SO COME UP WITH A BETTER ARGUMENT... PEOPLE REALLY NEED 2 GET OF DENDREON's **** (YOU INCLUDED... I guess everyone is entitled 2 an opinion even IF ITS THE WRONG ONE)!!!!

ljsampson1 said...

Why is "average" so hard for certain people to understand? Some patients will live years longer with this treatment. Also, you appear to be assuming that everyone who is eligible will opt for the treatment. I doubt that will be the case.

Anonymous said...

@ljsampson1 - Because it is an easy number to quote as is the price. I have yet to see a story include the price/side-effects of alternative treatments or 3 year survival benefit data on Provenge.

rangerpete said...

JDA: Please review DNDN again. The 4.1 month survival advantage is the median... meaning 1/2 of men treated w/Provenge lived more than 4.1 months v control group. A lot of men treated w/Provenge are still alive 3-4 years later. This means the average is much much higher...

FDA insists upon use of median to measure survival for arcane reasons, but this measurement can be very misleading...

Also, please understand the cost of Provenge as compared to chemo. You live longer w/Provenge, but the costs are not any greater... Rather, when you factor in treatment of all the adverse effects of chemo, cost for chemo and Provenge are about the same...

Finally, what about quality of life. Chemo kills and cripples a large number of patients. Provenge adverse effect is flu like sysmptoms...

So, what we are looking at is probably an average of 24-28 month survival advantage for Provenge, plus great quality of life, plus costs not any greater than chemo...

And the effectiveness of Provenge will increase as we study and learn more about it. Cheers, Pete

ljsampson1 said...

Thanks Pete. Nice summary.

rjfs1716 said...

@rangerpete I FULLY AGREE WITH YOU... I ACTUALLY AGREE WITH EVERYONE THAT HAS CURRENTLY COMMENTED ON THIS NONSENSE...

Anonymous said...

A mind is a terrible thing to waste. This blogger should have done their homework before running their mouth off. Provenge is actually on par with or cheaper than the toxic chemo therapy it is replacing. So the gov't is saving money by allowing medicare to pay for this treatment.

As soon as you all are done hating on me for expressing an opinion, I'm going to go milk my boyfriend's prostate. You know, like the good little patriot I am. It'll save Medicare a couple hundred thousand bucks in 20 years.

rjfs1716, you sound like you could use a good milking yourself.

Oh and thanks for the thoughtful commentary, Pete, it is appreciated.

Anonymous said...

It's not their fault, Jr Deputy Accountant. You made a blog post on something you don't quite understand, compare the cost of Provenge on a 4.1 month figure that is the MEDIAN number (aka: half of patients live a lot longer than this) and write things that are simply not true. It boggles my mind why you even wrote this on a subject you're clearly not an expert in.

embraceyourinnerhillbilly said...

Provenge is just the first step in immunotherapies. Throughout human history, mankind has improved upon their inventions.(e.g. from Kitty Hawk to the Moon in 66 years) The 4.1 median improvement in survival is just the beginning in turning cancer into a managable disease. Denying Provenge will derail the war on cancers and set back novel therapies besides chemo.
While the full treatment @93k is expensive, when you factor all the costs of treatments for side effects and the poor QOL issues of chemo, Provenge is not that expensive.
We are on the cusp of a New Age of
managing cancers. Costs will be high in the beginning...the price we pay for innovation.

rjfs1716 said...

LOL... Did we really have 2 turn the subject HOMO... Its all good everyone has a say so and i apologize for blasting off first no hard feelings homie!!!! :-D

rjfs1716 said...

My bad just realized your a female you can milk it any day :-D JUST REMEBER THE GOLDEN RULE NO DRIPLETS!!!! LMAO

Hugs, rjfs1716!

I'd also like the record to reflect that I have absolutely nothing against Dendreon for taking advantage of this set-up, it's the American way! I say get it if it's ripe for the taking, which it certainly appears to be.

More power to those who can capitalize on the gaping flaws in our system.

rangerpete said...

Thanks JDA: I believe you make an essential point. That is what are we as a society willing to pay to prolong life? There is some great literature on point suggesting the entrenched medical system pushes innefective and inefficient procedures upon reluctant elderly patients who (in many instances) would be better off left to die at home w/their families.

Instead, tax payer money is taken by the feds, or by the medical insurance providers, and paid to big pharma, medical device companies and doctors and hospitals... and their attorneys and lobbyists, etc...

Insofar as you are attempting to look at this systemically, I applaud your efforts. But I respectfully request you take another look at Dendreon. Maybe one of the last great industries remaining in our country is bio-tech, and DNDN is a magnificent endeavor.

I double dog dare you to read Mark Mitchell's Michael Milken, 60,000 Deaths, and the Story of Dendreon. I honestly believe Dendreon's story is heroic, and their contributions in the field of cancer immuno-therapy are herculean.

Of course I may be biased insofar as I own a bucket load of DNDN, but if you want an expose on In-Your-Face Financial Corruption on Wall Street, you simply must read this article.

Cheers again, Pete

rangerpete said...

Oopsie. Here is the link:

http://www.deepcapture.com/michael-milken-60000-deaths-and-the-story-of-dendreon-chapter-1-of-15/

W.C. Varones said...

All these greedy DNDN cheerleaders just illustrate the point.

Everybody wants unlimited revenues from the government. And in the aggregate, that bankrupts us.

John Parker said...

There are a few problems with this analysis, namely the fact that Provenge is not a medication for patients with a "low quality of life". In fact, in the clinical trial demonstrating Provenge's efficacy and safety, patients were only selected if they had an ECOG status of 0/1 (For reference, ECOG 0 = normal with no complaints and ECOG 5 = death). So provenge probably isn't going to be given to someone who is barely living and bedridden. Adding on to this is the fact that unlike many types of chemotherapy regimens, provenge has little to no side effects in most patients, further adding to the quality of life.

Also, this isn't the kind of drug everyone and their dog is going to receive. Only patients with hormone-refractory prostate cancer are approved to use provenge.

There are not many good treatments for hormone-refractory prostate cancer as of right now. As alternative drugs/therapies come to market then naturally the price of provenge may drop.

Anonymous said...

wow, seems you've really touched a gland, ummmm I mean nerve on this one....

Anonymous said...

I'm typing this with one hand and checking out my prostate with the other.

You make me proud, Anon! Don't get any on the keyboard.

rangerpete said...

"All these greedy DNDN cheerleaders just illustrate the point.

Everybody wants unlimited revenues from the government. And in the aggregate, that bankrupts us."

Dude: I get it. You are angry. So you lash out in a grade school manner???

This is sad... because if we are ever to reduce the size and corruption and budget and authority of the federal government, we need to do so in a thoughtful manner.

If you want to disband medicare, go ahead and make the case. I'm interested. You could make a compelling argument.

If you want to reduce the payments from CMS to medical providers, go ahead and make the argument.

But to call me greedy simply because I advocate ground breaking developments in the treatment of cancer and immuno-therapy???

Also, please try to understand the suffering of patients w/advanced prostate cancer.

Okay Dude, you decide. Who lives and who dies??? You make it sound so easy. You must be really smart, eh???

akcje said...

"That our system is designed to prevent any cost/benefit analysis is absurd and ultimately dangerous to the health of the majority of Americans.
"

Yes, this important and obvious point has been made many times and needs to be repeated again and again, until the corrupted congressmen get replaced by some who actually work for US rather than for themselves.

But why you chose that idiotic illustration to picture patients dying of cancer may perhaps explain why the voters like you deserve the politicians you elect.

Actually that picture was supposed to represent the taxpayer getting assraped by deals like this. I fully support men's heath, that's why I take care of mine.

Can't have him bankrupting already bankrupt Medicare once he's past his prime, ya know.

W.C. Varones said...

Rangerpete,

It doesn't take a genius. If you're going to have communist health care, the government negotiates lower drug prices. See Canada. Their health plan is infinitely better than the ObamaCare nightmare in many ways, especially cost control.

Or if you don't like Canada, how about the Purple Health Plan, which has a number of cost control mechanisms?

You can't have free health care with no rationing. Do the math.

Ken said...

I just wanted to add that with Dendreon Corp, cancer is a very personal matter.

Dr. Mitchell Gold, founder & CEO of the company, lost his 26-year old mother to cancer.

For Dr. Gold, this is nothing less than a crusade to rid the world of the scourge that is cancer.

For Dendreon Corp, Provenge is only the opening salvo of Gold's war on cancer, as the company's pipeline is filled with more new weapons for the fight against cancer.

Yes, it's expensive, and so is the long road to getting FDA approval for any medical treatment. As someone who lost a love one last year to Stage IV stomach cancer, I wish Dr. Gold nothing but the best of luck, & appreciate the efforts from him & all others who are working to make a difference.

W.C. Varones said...

Rangerpete,

It doesn't take a genius. If you're going to have communist health care, the government has to negotiate prices. See Canada.

You can't have free health care for everybody with no rationing or price controls. It's basic math.

Ken, thanks for that, adds something useful to the discussion.

W.C. Varones said...

Curing cancer is great.

The problem is that nobody in power has given the slightest amount of thought to health care financing -- especially those involved in the ObamaCare abomination.

Because of the contorted finance system that relies almost exclusively on third-party payer, we have the most expensive health care system in the world, and we are much further from universal coverage than many countries who spend a fraction of what we do.

Then there's the free rider problem on drugs. Canada and Europe negotiate deeply discounted drug prices, but the U.S. pays full freight. U.S. consumers and taxpayers are paying for the entire world's drug development costs.

W.C. Varones said...

Rangerpete,

It ain't just me who notices this.

The esteemed and quite moderate Professor James Hamilton writes on the same thing this morning.

W.C. Varones said...

Rangerpete,

It ain't just me.

The esteemed and quite moderate economics Professor James Hamilton has a post on the same subject today.

rangerpete said...

Varones: I agree 100% we need to fix health care. But singling out Provenge to describe what is wrong w/CMS is plain silly. We need to fix it systemically. I've been advocating a reduction in the size and scope of the federal goct for twenty years. You don't need to convince me...

Anonymous said...

well, it looks like you squeezed and wrung out all the PSA's from *that* prostate...I'm starting to think the readers here are mostly old geezers who fear the afterlife...speaking of which, I'm gonna start my own church for the tax bennies - Old Codgers for Christ or Church of the Trout (where we baptize elk hair caddis and Adams flies in the living waters of the Current River every Spring - weather permitting) or The Pheasant Tabernacle.

Anonymous said...

"Actually that picture was supposed to represent the taxpayer getting assraped by deals like this"

Most boomers are complete pussies where it comes to facing their own mortality - they'll pay any price (or ask someone else to pay any price) to hold off the inevitable for as long as possible. I suspect that many health care providers are well aware of the psychology and use it to their benefit wherever it will generate revenue. There's a price to pay for all those years of cheese fries, cheap beer, gym memberships that go un-used after February, annual serving of fruit and veggies, bacon wrapped steaks, etc. but by God, they dodge that debt for as long as they can...

Afterall, it takes a lot of dough to keep all the hot little blonde girls in the pharmacutical sales business, right?

Your pal,
Smug Bastard

Anonymous said...

As a Stage IV Prostate cancer patient for the last 6 years , I was turned down for the Provenge study and have been waiting for approval .
I am thrilled that it is now medicare approved even though I am still too young to take advantage of it , however this probably means that my medical insurance will probably cover it in the near future.I have paid for medical insurance for the last 32 years with no exhorbitant costs to the company.

The Chemo cost over the long term is greater than Provenge and terribly toxic. Provenge is a new direction for cancer treatment in this country. Instead of poisoning the patient it helps the patient actually fight the disease.Provenge has been on my disease treatment flowchart since 05 just waiting.
I am very excited about the future just knowing it's there.

Quality of life is worth more to me than just having a heartbeat so I have no plans to use chemo in the future .

What is your life worth to you per day ? would you pay $1000 a day to live an extra 90 days in relatively comfortable circumstances. I would.

Although I was turned down for the study in 2005 , I watched DNDN stock and bought it at $3.75 so I have made enough for several rounds of treatment with Provenge !!

Anonymous said...

"I watched DNDN stock and bought it at $3.75 so I have made enough for several rounds of treatment with Provenge !!"

Bully for you - why wait for insurance coverage? With the boffo bucks you've made in the stock market, might I suggest you use some of it, head down to ole Mexico and pay for your treatment now? It is ONLY money afterall...

Jeff

Anonymous said...

$3.75 to $41 per share since 2005... that's a fabulous gain... so in a way, even if it is declined coverage, you're treatment is in the bag...

Anonymous said...

"On a general basis, to survive is worth anything," says Bob Feutz, 84, of Redmond, Washington.

*especially* if someones else is footin' the bill....

Got a little bad news for you Bobby.... we all die one day and if the old glands don't get 'cha then a bus or a meteorite or a jihadist will. You've made it from the Roaring 20's to the Great Depression to WWII to Korea to Vietnam to Watergate to Reaganomics to I did not have sexual relations with that woman to World Trade Center to now... my hat is off to your survival abilities. I really can't believe you are not just bored with the whole mess by now. I mean, what do you suppose is going to happen in the next six months that is going to be so worth sticking around for? Anything you HAVEN'T seen by now?

rangerpete said...

Sadly, Provenge is not available in Mexico... or anywhere else in the world, other than in the Northeast of the US right now. Having delayed approval of Provenge for years, the FDA should be held responsible for the painful death of 60,000 men... but our federal agencies are no longer accountable...

The FDA finally approved Provenge just about a year ago, and only approved last month the expansion of the manufacturing facility in NJ. We are still awaiting FDA approval manufacturing facilities in LA and Atlanta...

So there will be a significant backlog of patients for quite some time. Sadly, many of these patients will die while waiting...

Big pharma and hedge funds shorting DNDN were able to delay Provenge.

Here is a link: http://www.deepcapture.com/michael-milken-60000-deaths-and-the-story-of-dendreon-chapter-1-of-15/

Anonymous said...

they'll pay any price (or ask someone else to pay any price) to hold off the inevitable for as long as possible


"On a general basis, to survive is worth anything," says Bob Feutz, 84, of Redmond, Washington.

What is your life worth to you per day ? would you pay $1000 a day to live an extra 90 days in relatively comfortable circumstances. I would.

thank you - my point has been made...

Anonymous said...

Antigen presenting cells (APCs), a class of cells that includes dendritic cells and macrophages, are of major importance in immunotherapy. They are distributed throughout the skin, respiratory tract, and gastrointestinal tract. APCs serve two major functions: they capture and process cell-surface markers, or antigens, for presentation to the T class of lymphocytes. And they also produce signals that are required for the proliferation and differentiation of those lymphocytes.

For several years, dendritic cell vaccines have been offered at CAM-oriented clinics in Mexico, the Caribbean and northern Europe, but have not been available in the US outside the strict confines of clinical trials.

According to the Seattle Times, "the treatment has numerous skeptics." These include Patrick Walsh, MD, a Johns Hopkins University urologist and a well-known prostate-cancer surgeon, who said the study was too small to allow definitive conclusions. He said it was unknown what other therapies patients may have had during the three-year follow-up period, which may have made a difference.

uuuuuuuuhhhhh, really...???? 'cause when I go ask Mr. Google "provenge Mexico treatment" he comes back with all sorts of shit ???

Anonymous said...

dendritic cell treatment, get your dendritic cell treatment

In the latest study, men who were treated with Provenge survived on average 26 months, compared to 21.4 months for those who received only a placebo injection

well shit, four more months of the wife and kids??? sign me the fuck up already!!!

Anonymous said...

you know I saw a program about autopsies done on a boat load of 100 year old + dudes who all died of something other than prostate cancer and you know what the autopsies revealed? every one of these old farts had some stage of prostate cancer development or enlargement or something weird going on with the old juicy juice gland. every last one of them. the examiners concluded that if you are able to live long enough, your old juicy juice gland is gonna go a little screwy.

Anonymous said...

this shit was FDA approved in 2010 and is gaining traction

Medicare coverage of Provenge, which costs $93,000, is key since the disease strikes mostly older men. The program covers those aged 65 and older along with the disabled, and about 40 percent of its 46 million enrollees are men.

A final decision is expected by June 30.

So, how many people do you think are gonna start claiming disability to gain access to Medicaid covered treatment?

Anonymous said...

18.4 million males enrolled and say dwindle that down to half so say 3.2 million covered for Provenge treatment at $93,000 a piece and that comes to about... shoot... you're the mathlete on this site... so what does that come to?

Other than skin cancer, prostate cancer is the most common cancer in American men. The latest American Cancer Society estimates for prostate cancer in the United States are for 2010:

•About 217,730 new cases of prostate cancer will be diagnosed
•About 32,050 men will die of prostate cancer
About 1 man in 6 will be diagnosed with prostate cancer during his lifetime. More than 2 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 36 will die of prostate cancer.

Anonymous said...

Dr. Frank says, “Cholesterol does indeed seem to be an important factor in the regulation of tumor formation in several cancer types.” A study published in December 2010 found the same association between prostate cancer cholesterol and prostate cancer growth, published in the American Journal of Pathology.

might I suggest a piece of fucking fruit every once in a while?

The scientists measured several biomarkers showing more advanced stages of cancer in the mice given the typical American diet, confirming that cholesterol and fat in the made breast cancer more aggressive. Studies also link a fatty diet to development of pancreatic cancer.

Anonymous said...

hey WC are you reading this??? Are you thinking of the guy with the giant plate full of bacon with maple syrup drizzled over the top of it at the Home Town Buffet??? I am...

Anonymous said...

oh, that's right, I forgot .... real men eat fucking red meat smothered in cheese sauce at every meal... fruit is for pussies and homosexuals....my bad

Anonymous said...

"And in the aggregate, that bankrupts us."


Who cares? Where's MY cheese and when does Idol come on the teeeeveeee?

Where's my plate of bacon and where is the remote control?

wcv said...

Anon,

Oh, yes, I'm reading this.

I don't give a shit what people eat or put up their asses until they want me to start paying for it.

And yeah, Provenge is probably a great thing. But so are lots of $100,000 treatments and the government can't afford to give everybody unlimited quantities of the latest drugs at unlimited prices.

Bacon and syrup are probably the answer. If we can get all these fuckers to have heart attacks in their 40's, we won't have to worry about prostate cancer in their 60's and 70's.

Anonymous said...

"I don't give a shit what people eat or put up their asses until they want me to start paying for it."

Can I get a big AMEN! from the congregation?

AMEN!!!