Medicare: Easy way to cut

iVillage Member
Registered: 10-25-2006
Medicare: Easy way to cut
Sat, 07-02-2011 - 9:14am
This is absurd....spending $93,000 to extend the life of a very sick person only 4 mos.


From Medscape Medical News CMS to Pay for Provenge for Metastatic Prostate Cancer

Nick Mulcahy

June 30, 2011 — In a final decision memo, the Centers for Medicare and Medicaid Services (CMS) announced today that it will provide coverage for the use of Provenge (Dendreon), the prostate cancer vaccine known generically as sipuleucel-T, in patients with asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer.

"We are optimistic that innovative strategies may improve the experience of care for our beneficiaries who have cancer," said Donald M. Berwick, MD, administrator of CMS, in a press statement about the coverage decision of the unique treatment, which is derived from a patient's own white blood cells. "CMS is dedicated to assuring that these patients can seek the treatments they need in accordance with their wishes."

The announcement means that the coverage decision is in keeping with the US Food and Drug Administration's (FDA's) indication for the vaccine.

"CMS is covering Provenge nationally only for those indications supported by evidence and consistent with the FDA label," said Patrick Conway, MD, chief medical officer and director of Office of Clinical Standards & Quality at CMS.

Off-label usage will not be covered nationally but instead will be left for local Medicare administrative contractors to decide upon, according to CMS.

Off-label usage is likely to be highly scrutinized. "We do not believe there is any persuasive evidence for the off label use of sipuleucel-T at this time," reads the National Coverage Decision memo from CMS.

The new coverage decision comes after an unusually protracted review by CMS of Provenge, which costs $93,000 for a typical course of 3 treatments.

The vaccine was subject to a CMS National Coverage Analysis, which included a review by a federal panel known as the Medicare Evidence Development and Coverage Advisory Committee.

In November 2010, the committee gave what amounted to a middling vote of confidence for the on-label use of Provenge and a rejection for off-label use.

The combination of the high cost of Provenge and an atmosphere of high-intensity federal budget scrutiny contributed to widespread news coverage of the therapy and the CMS review.

However, there have also been questions about Provenge data because of potential confounding effects of subsequent treatments of some patients in clinical trials. In a technology assessment quoted in the CMS decision memo, the assessment authors noted that the benefit from Provenge occurred in clinical trials that included chemotherapy. "This treatment effect occurs in the context of use of post-progression chemotherapy," the document reads.

Although referred to as a vaccine, sipuleucel-T is actually an autologous active cellular immunotherapy, which means that it is made from the patient's white blood cells and stimulates a patient's immune system to respond against the cancer. The treatment needs to be manufactured individually for each patient.

Sipuleucel-T was the first product approved by the FDA in a new therapeutic class known as active cellular immunotherapies.

In a pivotal phase



iVillage Member
Registered: 11-27-2009
Tue, 07-05-2011 - 7:46pm
"That's better than the right-wingers who are okay with letting children who happen to be born into poverty go without basic necessities, and don't want POOR people to be a burden to the taxpaying society. "

Can you support that opinion?
iVillage Member
Registered: 05-13-2009
Tue, 07-05-2011 - 7:52pm

<24.1% reduction in the risk of death>

Dead is still dead, whether its 25.8 or 21.7 months, no matter what terms you use. Do you have a different understanding of the hazard ratio?

Really? What party has proposed a radical plan to cut billions for healthcare for seniors by implementing a voucher plan for purchase of private insurance. I'm sure you have no problem with private insurance companies denying coverage to for life extending cancer treatment because it does not fit into its for profit business model.

The reason medicare was enacted is because the elderly (and poor) had little access to private health insurance options. It looks like the republicans wish to return to that golden age.

My 91yo uncle died recently. The cause wase related to his prostate cancer. He had a long and fulfilling life, he died in his own home with occasional help with a wonderful home health care provider that he paid for oop. I do not know the particulars of his treatment, but I believe he refused aggressive treatment for his cancer. He left this world on his terms,vaya con dios.

Liberals, like me, want a true healthcare safety net for seniors and the poor alike. If prohibitively expensive treatments like Provenge and Avastin can not be offered to all on Medicare due to a comprehensive cost benefit analysis. I've got no problem with that as long as game changing preventative and cost effective life extending care is offered to all.

iVillage Member
Registered: 06-07-2011
Tue, 07-05-2011 - 7:53pm
((Greedy, greedy, greedy...))

It's not greed at all. It's called personal accountability.

What is strange is how the left wingers don't want to pay for healthcare for the elderly....and expect that they should "be okay with their mortality" and just go ahead and die, because after all, they have lived long enough.

Then, the left wingers are okay with mothers killing their unborn children and using abortion as a method of birth control. Then, they want the taxpayers to pay for these poor children who are born, pay for their food, diapers, daycare, and education. Of course, they don't think that they should pay for it.....just the rich people.

Watch out old people....the progressives don't give a hoot about you. Just go ahead and we will have enough money to pay for the welfare mama's and their 6 kids (all by different dads and none of which pay child support).

Watch out cancer patients....your next!

iVillage Member
Registered: 05-13-2009
Tue, 07-05-2011 - 9:03pm

Really - who's plan guts medicare as we know it? Psst, it's not the Democrats. Cost containment of all medical costs, not just medicare is key.

I'm pretty sure that abortion is not a left/right issue with the actual people who choose to abort. In a perfect world, every child would be wanted; loved and cared for. In this imperfect world, a woman has the right to choose.

Really? Because Paul Ryan's plan reeks of compassion and concern for the elderly. Poor at 65? Bad choices, too bad, here's a voucher to buy private health insurance, good luck with that. I'm sure you'll choose the best in this new free market commerce (Psst dont get sick)

iVillage Member
Registered: 06-07-2011
Tue, 07-05-2011 - 9:18pm
Have you read some of the posts on this thread? Because to me, they sure sounded like old people should just be okay with their mortality and go ahead and die, as not to burden the younger taxpayers with their expenses on medical care. After all, there is day care to pay for.

iVillage Member
Registered: 05-13-2009
Tue, 07-05-2011 - 9:29pm
I've read them all - and I've participated - Can you point to where I've ever said it's ok for old people to die? ....

I am not a progressive - I'm a liberal (maybe leaning on socialist area). I believe in balance budgets, tax increases for the rich (myself included), and cost constraints based on good policy.

iVillage Member
Registered: 11-27-2009
Tue, 07-05-2011 - 9:52pm
There was a post that suggested that the money be better spent on a 5 year old for basic necessities and preschool, instead of for the treatment of cancer for a senior citizen medicare recipient.
It wasn't hard to infer that the suggestion was to let the senior die.
iVillage Member
Registered: 05-13-2009
Tue, 07-05-2011 - 10:01pm

One person on an anonymous debate board making a statement doesn't suggest all "progressives" want seniors to die of cancer.

Paul Ryan putting a stake in the ground for the conservative cause suggests that "conservatives" want to radically change medicare .Do you really disagree?

ETA - One of the conservative people on this board equate all gay people to NAMBLA. Do you agree with that?

iVillage Member
Registered: 06-07-2011
Tue, 07-05-2011 - 10:27pm
((I've read them all - and I've participated - Can you point to where I've ever said it's ok for old people to die? ....))

Sorry, but I never claimed that YOU said that. Nice try though.
iVillage Member
Registered: 11-27-2009
Tue, 07-05-2011 - 11:56pm

That is true, however, I've read enough to know that this idea or thought is not limited to one person on a debate board. In fact, Ezekiel Emanuel and Boderheim (I don't think I've got that name right but it's one of Emanuel's peers that also serve this administration) feel the same way, and Emanuel has a top spot for health care in the Obama administration.

I usually ignore any finite comments like "all", "everyone", "always".