Costs Will Have to Be Covered

The new antibody drug conjugates (ADC) undoubtedly constitute an enormous gain in the treatment of advanced tumor disease. But as a medical community we will not get round starting to think about for which patients we will use these extremely expensive medications. The drug trastuzumab deruxtecan, for example, is in patients with breast cancer and Her2 expressing tumors also licensed for Her2-low tumors that express the marker only weakly, not—as has been the case until recently—only for tumors that are strongly overexpressing. These Her2-positive tumors—low and high—account for some 80% of all breast cancers. In 75 000 primary tumors and some 18 000 death per year, this means that tens of thousands of patients every year are eligible for treatment with just this one drug. The treatment is administered every three weeks and the costs per application as covered by the statutory health insurers is about €7000, which translates into annual therapeutic costs of some €120 000 per patient. And this is only one drug among several. We will have to face the question of whether the statutory and private health insurers—which are going to try to save these amounts elsewhere—will be able to rise to the challenge or whether we will need to formulate who should be given these drugs in which situation. Politics are not going to relieve us of this ethical dilemma.