How much is a life worth?

By Roxanne Patel Shepelavy

updated 10:40 a.m. ET Oct. 11, 2007

Michelle Diekmeyer lay awake in the dark, trying not to panic. It was a struggle she seemed to be losing more and more every sleepless night in July 2005.

Seven months after being diagnosed with stage IIIB inflammatory breast cancer, 37-year-old Diekmeyer had spent nearly 100 days in doctors' offices or the hospital near her Ohio home. She'd had five surgeries, with another scheduled for September; slogged through more than three months of grisly chemotherapy; suffered the indignities of baldness and violent nausea. After all that, she still didn't know if she'd survive the year.

But Diekmeyer had another, more immediate, fear keeping her up nights. Because of mounting medical bills, she was worried she might lose her home. Already, Diekmeyer owed her oncologist more than $10,000, debt that had escalated since May 2005, when she started taking Herceptin, a cutting-edge cancer formula. Produced by Genentech, a leading manufacturer of biotech drugs in South San Francisco, California, the new medicine was her best — perhaps her only — hope of beating the disease.

It was hope that came with a steep price: Every three weeks after her IV infusion of Herceptin, her insurance company paid her doctor 70 percent of the cost of treatment. The rest — about $1,500 — was supposed to come from Diekmeyer. But she and her husband, Randall, a networking manager for an architectural engineering firm, had already depleted their modest savings on her medical bills; they'd cut out even small luxuries, like the daily newspaper. Diekmeyer was too sick to go back to her job as a church secretary. And she faced 10 more months of Herceptin and an unknown future of other treatments. Still, Diekmeyer had no choice. She either took the Herceptin or faced an almost certain death.

"How do I put a price on my life?" Diekmeyer wondered, not for the last time. "I can't. I just hope my doctors are patient about my bills. There's nothing else I can do."

Out of reach for many
Fighting cancer has always been one of the most expensive prospects in medicine — in part because the drugs that treat it are among the most costly on the market. But as Diekmeyer discovered, biotechnology treatments such as Herceptin are pushing prices into a whole other realm — one that may be out of reach for many people.

Nearly 15 years ago, Bristol-Myers Squibb faced congressional hearings over plans to charge up to $6,000 for a six-month treatment of Taxol, then a groundbreaking ovarian cancer drug. Now new biotech cancer drugs routinely cost $25,000 to $50,000 a year, with some running close to $100,000. The cost of cancer-fighting drugs went up 27 percent in 2006, compared with less than 2 percent for other drugs, according to the most recent Medco Drug Trend Report. And many of the new medications are being tested in combination, so patients may be faced with not one but two or even three drugs that cost $50,000 each. That's the case with ImClone's Erbitux and Genentech's Avastin, two of the priciest commonly used cancer drugs on the market, which are being tested together for colorectal cancer.

Genentech provided $205 million in free drugs to uninsured patients in 2006, according to Kristina Becker, a company spokeswoman. Other major drugmakers have similar programs. But many patients are like Diekmeyer: insured and reasonably well-off but still struggling to pay their portion of the bills. One in 10 cancer patients is unable to cover basics such as food and housing, according to a survey by the Kaiser Family Foundation in Menlo Park, California; more disturbingly, 1 in 12 people with cancer has delayed or decided against treatment because it was too costly. A recent study from another research group showed the problem is worse for insured women than insured men, in part because they take more prescription drugs.

"It's appalling to me that they can charge these kinds of prices," says Cathryn Miller, 51, a Seattle nurse with metastatic breast cancer.

INTERACTIVE Fact file Health care & costs, by the numbers

Miller's insurance company paid nearly $66,400 a month in the spring of 2006 for a cocktail of Avastin, Herceptin and the chemo drug Abraxane, eating up a big chunk of the $2 million lifetime cap on her plan. "If I'd had a 20 percent co-pay like a lot of patients I know, I'd be bankrupt now," she says.

The issue affects everyone, even those who are healthy: When insurers begin spending upwards of $25,000 a year per drug for every cancer patient, the entire health care system is going to feel the strain. Which means all of us are going to feel it in higher premiums, fewer choices and less access to any kind of care.

"Is society willing to bear the cost of these drugs to save the lives of these women?" asks Marisa Weiss, M.D., an oncologist in Narberth, Pennsylvania, and founder of BreastCancer.org. "I say yes. But as a doctor, my responsibility is to my patient sitting in front of me, whose life I'm helping to protect with the best medical care possible."

Medicine is not like other commodities, and those who need it are not like other customers. They are often people desperate for a few more months of life—long enough, they hope, to be around for the treatment that turns out to be a cure. But where do companies draw the line between maintaining a profit that satisfies stockholders and gouging patients who'll pay anything to stay alive? The answer—if there is an answer—is something pharmaceutical companies, patient groups and lawmakers are struggling to find. "It's not like buying a high-priced car," when customers can walk away or shop around if prices are too steep, notes Dee Mahan, director of global initiatives for FamiliesUSA, a patient advocacy group in Washington, D.C. "There should be a level of public trust in the making and marketing of products that could save people's lives. I think we've lost that."

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