Results of research from the early Breast Cancer Triallists’ Collaborative Group in Oxford, UK, published online by The Lancet on July 24, 2015 showed that use of adjuvant bisphosphonates in the treatment of early breast cancer in postmenopausal women could reduce disease recurrence and mortality. Bisphosphonates, available in generic form, are inexpensive and should be available worldwide to improve care in this population.

Unfortunately, new treatments for cancer are rarely so inexpensive. A recent petition published in the Mayo Clinic Proceedings was co-signed by 118 US cancer physicians. Entitled ‘in support of a patient-driven initiative and petition to lower the high price of cancer drugs’, the article points to the escalating cost of cancer therapies. The price of new cancer drugs in the US has increased five-to-tenfold in the past 15 years. 

All new US Food and Drug Administration (FDA)-approved cancer drugs in 2014 were priced higher than US$120,000 per year of use. Even in patients with health insurance the co-payments have pushed user contributions up to 20-30% of drug costs, despite the average annual US household income being around $52,000.

The Mayo Clinic Proceedings commentary also draws attention to ways in which the high pricing of cancer drugs could be challenged, including a fair pricing review process after FDA approval, which would allow Medicare to negotiate drug prices and to open up drug imports from neighbouring countries, notably Canada, where drug pricing is around half that in the US. An online petition, seeking one million signatures to amplify concerns in a grassroots campaign, is gathering momentum.

The World Health Organization (WHO) has recently added 16 new cancer drugs to its Essential Medicines List, including imatinib for the treatment of chronic myeloid leukaemia, which costs around $100,000 per year of use. WHO considers the core list to represent “the minimum medicine needs for a basic healthcare system”. Whether the costs are borne directly by individual patients or indirectly through taxation or insurance, it is clear that only those at the high end of global wealth will have access to the latest treatments.

As medicine moves from the art of the possible to the art of the affordable, rationing of healthcare is already a reality. The challenge is to ensure that maximum benefit in terms of patient outcomes is delivered from the escalating cost of new treatments.