COSTS AND METHODS

The annual 2023-2024 drug costs were quoted and calculated in United States (US) dollars. With exception of Ivonescimab, all the analyzed drugs are currently approved and widely used in US, Europe and Canada.

RESULTS

The addition of Blinatumomab to chemotherapy improved the outcome in pediatric B- ALL [1] at an estimated total cost of 2 courses $178,000. The previously proposed annual Bispecific AIvonescimab cost in advanced/metastatic non-small cell lung cancer ((a/m-NSCLC) was $250,000 and the 9- month course $188,000 (2-4). Trastuzumab Deruxtecan cost was $166,000, ICI $150,000-$160,000, median of 5- TT in a/m-NSCLC $210,000 (5), Osimertinib $153,000 [5-7], oncogenic driver testing $4,000 and generic chemo $1,000 (Table 1). In comparison, the GLP agonists ranged from $1,100- $1,060. The anti- plaque therapy costs of Evolocumab administered sc was $30,000 and iv Donanemab-azbt $32,000 (Table 2).

DISCUSSION

Anticancer drug costs are commonly negotiable and generally labeled excessive. Drug costs multiply with the number of purchases [10]. Cost matters [13] but value counts most [14,15]. If drugs are unaffordable, value is worthless. Except for Ivonescimab [2-4], values of all the analyzed drugs were approved and utilized in the US, Canada and Europe. Blinatumomab added to chemo improved the outcome in pediatric B-ALL [1], offering a new and fresh hope to young children with rather fatal outcome. Synthesis of the Bispecific 2-hook arsenal Blinatumomab is a complicated process justifying its relatively high $178,000 cost. The 4-indications of the ADC Trastuzumab deruxtecan with its payload complexity and linker had ultimately increased the number of eligible patients and lowered cost, rendering the drug more accessible for limited-income patients and countries. The ICI [5-9] with and without chemo, have been for the last 10 years, the main platform foundation of cancer therapy. Their patency is coming to an end with an anticipated significant cost reduction. Subcutaneous (sc) formulations are being introduced and will be soon on the market.

In a/m-NSCLC TT are generally approved at 2-3 years. Further use is currently recommended as long as effective and safe. Osimertinib overall survival has been confirmed at 5-years, supporting its 5-year cost. The projected cost of other TT beyond 2-3 years is too high to be tolerated. Clinical trials, doubtful to be initiated by pharma, are needed to test efficacy of other classes e.g. ADC or Bispecific after the end of the indicated terms of approval. The incidence of disease in the US, relative to population number was explored in diabetes mellitus and Alzheimer. According to the Centers for Disease Control and Prevention (CDC) on May 15, 2024, a total of 38.4 million people has diabetes (11.6% of the population). In 2023, the U.S. had an obesity prevalence higher than 20%. Nearly 1 in 3 adults (30.7%) are overweight. More than 1 in 3 men (34.1%) and more than 1 in 4 women (27.5%) are overweight. About 1 in 11 adults (9.2%) have severe obesity. It is worth noting that obesity is linked to an increased risk of many cancers, including breast, colorectal, esophageal, kidney, and liver cancer. The introduction of the GLP-agonists is a welcomed and timely class for diabetes mellitus type 2 and obesity treatment. Alzheimer's disease incidence increases significantly with age. About 1% of people aged 65-74 years develop the disease each year and increases to 10% for those aged 75-84 years and 50% for those aged 85 years and older. Recently 2 new drugs were developed capable of slowing the disease progression at an estimated annual justifiable cost of Evolocumab at $30,000 and Donanemab-azbt at $32,000. Both drugs target the harmful amyloid plaques.

SUMMARY

Anti-cancer drugs/classes are reasonably priced and consistent with their value, only if used within the terms of approval. TT cost beyond 2-3 years is financially toxic [16,17]. It is unfair to label all anti-cancer drugs expensive without in-depth cost analysis of the reasons behind the scenes. Synthesis of the safe Bispecific Blinatumomab is complicated and tedious. Time. patience and expenditure led to recovery of time, efforts and clear justification of Blinatumomab relatively high $178,000 cost. The complexity behind any ADC structure is an expensive and demanding process. The 4- indications of the ADC Trastuzumab deruxtecan was particularly profitable to Pharma, leading to an increase in the number of eligible patients. Costs of GLP-1 agonists and Alzheimer therapy need further calibration and adjustments in view of the large number of consumers. Good faith negotiations [18] are vital in cost control. It is hoped that artificial intelligence with 3-D photography will accelerate drug synthesis at lower costs.

CONCLUSION

Costs of Blinatumomab and Trastuzumab Deruxtecan were priced fairly. Drug costs are largely determined by the magnitude of eligible consumers.

• 
  Table 1
• 
  Table 2