Spanish public hospitals pay 307,200 euros for each personalised childhood leukaemia treatment

Public hospitals pay 307,2000 euros (without VAT) for each treatment of Kymriah, a novel CAR-T therapy, developed by Novartis, for two types of blood cancer. Although the Ministry of Health had published the figure of 320,000 euros, as confirmed in a resolution of the Transparency Council, that is the maximum price set for each individual treatment, but it is not the actual price Administrations pay. The effective price of 307,200 euros is lower and only comes to light today for the first time due to the opacity that continues to characterise relations between the government and the pharmaceutical industry.

In order to find the real cost of Kymriah, Civio obtained three different public contracts showing the same unit price. The contracts are from the Gregorio Marañón Hospital in Madrid, which will spend about three million euros total to treat nine patients between 2019 and 2021; the Management of the Health Sector of Zaragoza 1, which also includes VAT, bringing the unit cost from 307,200 euros to 319,488 euros; and the Consorci Hospital Clínic de Barcelona, which awarded a contract to Novartis for about 1.6 million euros with VAT for five therapies.

Opacity in drug prices

A few months ago, the Ministry of Health began publishing the maximum price it is willing to pay for all new drugs, but not the actual price paid to providers, which it usually negotiates downward, behind the scenes. In other words, there is no official data from the government about what it actually pays for drugs, including CAR-T therapies. But the multiple purchasing agencies, which include state entities, autonomous regions and the health platforms of autonomous regions contract their acquisitions separately. Some of the contracting documents, whether by conviction or by mistake, reveal the actual prices paid to pharmaceutical companies. The unit cost is the same in the three cases we know: 307,200 euros without VAT for each Kymriah treatment. In 2015 Civio resorted to similar disparities in regional contracting transparency to reveal the price of Sovaldi medicine for hepatitis C.

In negotiations with pharmaceutical companies, it is normal to hide the actual price paid for medications

Opacity is often the usual tonic in the relations between public administration and industry: the most common is that the real price paid for medicines is hidden. A very frequent way is to publish the total amount of the contract, but not the effective price paid for each treatment or the number of units that will be administered. For example, the government of the Basque Country published on its public procurement platform a resolution of adjudication to acquire Kymriah, detailing the total budget without VAT (about 16 million euros), but without breaking down the cost of each individualised treatment or the number of therapies included. Asked by Civio, the Euskadi Corporate Pharmacy Service refused to confirm if Kymriah’s unit price was 307,200 euros. The reason? The signing of a non-disclosure agreement with Novartis, which prevents public administrations from publishing the prices negotiated.

CAR-T treatments are very expensive, but they have also been a real turning point in medicine. Both Kymriah and Yescarta are intended as last resorts for patients whose previous therapies have failed. Still, CAR-T therapies are not risk-free, as reported by the independent publication Prescrire. Kymriah or Yescarta can lead to serious and even life-threatening side effects. So the Ministry of Health has designated a limited network of centres in Spain that can administer these personalised treatments while monitoring their impact.

According to the plan published by the central government, the maximum prices of Kymriah in other countries are similar to those set in Spain. According to this document, in France it is 320,000 euros, after the approval of a temporary authorisation for the use of the medicine. In the United Kingdom, Kymriah costs 282,000 pounds per patient (approximately 328,000 euros). That is, the figures are very similar despite the different wealth of the different countries. That contradicts a mantra repeated by the pharmaceutical industry: one European industry representative said a few weeks ago that secret negotiations allows the poorest regions to pay less for medications. Our evidence, at least in cases such as these CAR-T therapies, Sovaldi and several vaccines, says otherwise.