Pharmaceuticals giant Roche is planning to reimburse hospitals every time its cancer drug Avastin fails. What does this mean in practical terms? When a patient's condition worsens, it works to the hospital's advantage. Critics call the idea of creating a business model around the effectiveness of a medication a "scandal," and "blatantly against the law." Unrelated to the marketing plan, doubts about the drug have also been cast.

Every patient should be able to assume that his or her doctors are happy to see an improvement in their condition. However, Roche's new plans could disturb the balance of that relationship between cancer patients and their doctors, and even create conflicts of interest for the doctors. If hospitals sign the contract Roche is putting before them -- of which Süddeutsche Zeitung has obtained a copy -- then thereafter it would mean that the hospital would stand to make money whenever a patient's condition worsened.

In an innovative "Pay for Performance" contract, the Swiss-based pharmaceutical company is presently making hospitals in Germany the following offer: they would be reimbursed for Roche's Bevacizumab cancer medication (trade name Avastin) if it failed to halt the progress of a cancer. The offer is valid for first treatment of advanced tumors of the intestine, breast, lung or kidneys. Per month, the cost of treating a cancer patient with Avastin in Germany amounts to around 3,300 euros.

"It's a real scandal," says Wolfgang Becker-Brüser of the Arznei-Telegramm, an independent clearinghouse for medication information for doctors and pharmacists. The current issue of the Telegramm features the story. "This is an invitation to treat with Bevacizumab patients whose chances of being helped by the drug are very slim." It could even mean that more effective treatments were withheld from patients.

"We stand by the contract," said Roche spokesman Hans-Ulrich Jelitto, adding that it also represented a contribution to lowering costs in the health sector.

Some are questioning if the arrangement isn't simply a way to keep Avastin on the market. Its usefulness to patients has come under question because, while it does appear to slow the spread of cancer, patient survival rates are only slightly superior or equivalent to survival rates of those who received more usual cancer treatments. With regard to breast cancer, the doubts are so strong that the U.S. Food and Drug Administration (FDA) is moving to withdraw approval of Avastin for treating breast cancer.

Roche's lawyers on the case

It is in this context that Roche is making its offer to hospitals, saying essentially: sign the contract, and you'll be reimbursed for money you never actually spent – because cancer treatment is reimbursed by insurers. Roche's offer is thus not only ethically iffy, says Becker-Brüser, but legally questionable. Andreas Heeke of health insurers AOK NordWest stated that it was "blatantly against the law." If hospitals signed the document, they would have to pass the price advantages on to the insurance companies, said the head of the pharmacology business unit.

But Roche has already given thought to the legalities. The contract offers the hospitals a "legal evaluation" that would dispel any issues, and Roche even argues that for hospitals to pocket the money is "legally persuasive and legitimate." The reason given is that the money they receive for medication from the insurers isn't for real costs, but rather for drugs administered, which they would do anyway.

The side effects of Bevacizumab can be extremely unpleasant. One in every two cancer patients suffers vomiting, three out of four feel weak, and every fifth patient suffers stomach or intestinal bleeding. Roche may be willing to reimburse when its drug fails. Nobody, however, can buy back the patient's suffering.

Read the original article in German

photo - pppspics