Life-saving cancer drug is a boon for patients, but price sparks debate

Nivolumab, an immune checkpoint inhibitor praised for its breakthrough approach to cancer treatment, celebrated this month its 10th anniversary since its launch by Ono Pharmaceutical Co. under the brand name Opdivo.

But while it is highly effective in treating several types of cancer, its extremely high price has reignited debate about how best to deal with expensive drugs and balance the financial burden on the health system and patients with the need for pharmaceutical companies to provide incentives create life-saving new medicines.

“If there had been even the slightest delay in approving (Opdivo), I would have died,” said Koichi Shimizu, 47, a labor and social security consultant in Sakura, Chiba Prefecture, near Tokyo. Shimizu had often faced the prospect of dying after lung cancer, diagnosed in 2012, spread to his brain and spinal fluid.

He received a dose of Opdivo in 2016, when it had just been approved for lung cancer treatment, and the tumor shrank quickly. He is grateful that the drug was approved just in time to save my life.

Opdivo was developed based on research by Tasuku Honjo, a distinguished professor at Kyoto University who won the 2018 Nobel Prize in Physiology and Medicine. Unlike traditional cancer drugs, Opdivo uses the body's own immune system to kill cancer cells.

In 2014, Opdivo was launched to treat melanoma, a type of skin cancer. The drug's use has since expanded to 13 types of cancer, including lung and stomach cancer. An estimated 190,000 patients have been treated with the drug.

But Opdivo is extremely expensive. Lung cancer treatment was originally reported to cost about 35 million yen (US$243,000) per year. Since public insurance programs, such as the high medical reimbursement system, cover patients' co-payments, Shimizu only had to pay about 25,000 yen per month in real terms.

However, rising overall national health spending has put pressure on public finances. As a result, Opdivo's price has been reduced by six times and is now less than a fifth of the original cost.

Recently, Japanese pharmaceutical companies have brought a number of expensive drugs to market, such as Eisai Co.'s Lecanemab, sold under the brand name Leqembi to treat Alzheimer's disease.

According to the Ministry of Health, national healthcare spending reached a record high of over 45 trillion yen in fiscal year 2021, and this number is estimated to continue to rise in subsequent fiscal years and beyond.

Although there is no price for a person's life, public spending other than insurance premiums and patient co-payments amounts to 17 trillion yen, leaving little room for further expansion.

Drug manufacturers are aware of the situation. Gyo Sagara, chairman of Ono Pharmaceutical, said: “In order to maintain universal health coverage, it is inevitable to keep drug prices under control to some extent.”

However, if prices are reduced solely because of the perception that they are too expensive, this will impact investment decisions in the development of new medicines.

If price cuts are imposed on the market, there are also fears that drugs from foreign pharmaceutical companies for rare diseases may no longer be available in Japan.

Shimizu, who was given Opdivo for about eight months, worries about future cancer patients.

“It would be unfortunate for future patients if good medicines were no longer available,” he said.

It's a difficult topic, but he hopes that a way forward can be found through broad discussion, including among patients themselves.

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