Please provide me with average selling prices paid for by US hospitals for consumable products used for treating liver cancer (2/3)
Hello! Thanks for your request for the average selling prices paid for by U.S. hospitals for embolization beads and catheter used for treating liver cancer. This question was particularly meaningful for me to answer, as my cousin passed away from liver cancer several years ago.
The short version is that after searching extensively through product websites, product catalogs, industry reports, scientific articles, and government sources, I’ve determined that the information you requested is not publicly available because companies do not publicly disclose pricing of medical devices and associated consumable products. Moreover, manufacturers often require "hospital purchasing departments to keep prices confidential."
However, I was able to identify a couple paid sources that may list this data and manufacturers may also disclose prices if contacted directly. I also determined the total cost of administering SIR-Spheres per a Medicare Payment Schedule. Finally, using market size and patient data for North America and Europe I was able to make a rough estimate for you on the per patient cost of radio-embolization/drug-eluting beads as consumable products. Below you will find a deep dive of my methodology, findings, and suggestions for continued research.
First, I familiarized myself with catheter embolization to ensure I accurately researched the product. I confirmed that catheter embolization is a "minimally invasive procedure" where synthetic "embolic agents" - IE the embolization beads or PVA - are inserted into a blood vessel via a catheter to stop blood flow. It is commonly used for treating liver cancer.
Whenever possible, I focused on the U.S. market, as you explicitly mentioned U.S. hospitals. This meant excluding DC/LC Beads and HepaSphere upfront from my analysis as they are not available in the U.S.
I researched each of the examples you provided, but none of their specific websites listed prices; they instead list dosage and quantity. For example, Boston Scientific's Embozene sell sheet and product catalog for Embozene, Oncozene Microspheres, and Contour PVA do not list any prices. However, my fellow researcher found a Medicare Payment Schedule that listed some price data for SIR-Spheres.
Having exhausted my search for actual or average price data, I dove into market size and general patient data to provide you with some rough estimates. These calculations also highlight the difficult in determining accurate pricing for these products as so much information is behind paywalls.
As I researched all the products you mentioned, I include links to the main sources I used for that in an Addendum at the end.
LACK OF PRICE TRANSPARENCY
I was unable to find specific prices for consumable products used for embolization, because manufacturers explicitly restrict price information and even require hospitals to "keep prices confidential." In 2007, a proposed Senate bill would have required manufacturers to disclose average prices to the public and regulatory agencies. However, "device makers successfully lobbied against it" citing manufacturer-funded research that medical device spending as been consistently at "6% of total U.S. health-care costs" since the 1990's.
As such, hospitals have to go to third-party entities that gather price data to get a sense of the average price of devices and associated consumable products. Such data is generally only available to members for a fee such as through the ECRI Institute's PriceGuide. Together, ECRI and Modern Healthcare provide a free price index for the top 10 hospital supply items. However, consumable embolization products do not make that list.
As prices are not publicly available, I moved on to make some educated estimates based on available information
A fellow researcher helped me identify one source on Sirtex that lists medicare payment rates of SIR-Sphere microspheres therapy. However, the document states upfront that "Coding for administration of SIR-Spheres microspheres can be complex. There is no consensus or consistency in the coding/billing for the administration of SIR-Sphere microspheres." The sheet also does not distinguish between the cost of the consumable products (IE the microspheres themselves) and the other devices and physician work involved in administering treatment. The cost of the microspheres themselves would be a percentage of the following values.
The 2016 medicare payment schedule for "Microspheres Administration - tumor embolization or occlusion, inclusive of all radiological" is the following:
Surgery Center: $5,984
Physician Facility (at a hospital): $609
Physician Non-Facility (at a free-standing office): $9,912
Based on these values, total microsphere administration using SIR-Sphres costs range from $6,593 (doctor at a surgery center) to $10,151 (doctor at outpatient hospital).
As I was unable to determine an average price based on what manufacturers charge or hospitals spend, I next researched the total market size of the radio-embolization micro-spheres, drug-eluting beads, and non-drug eluting, non-radio PVA markets thinking that I could then estimate the average cost per patient. Unfortunately I found no such data for non-drug eluting, non-radio PVA, but was able to find information for the other two.
The Millennium Research report "Transcatheter Embolization and Occlusion Devices Market Analysis by Type of Product - Forecasts to 2022" states that the 2014 total global market was $2.2 billion in 2014 and estimated to grow at a C.A.G.R. of 10.1%. This implies that by 2016 the total global market was around $2.667 billion (I used this calculator to back into the ending value using a 10.1% C.A.G.R. over two years). North America and Europe comprised 54% of this market in 2014. Assuming they comprise the same amount in 2016, the North American and European market is worth $1.44 billion ($2.667 billion * 54%).
Unfortunately, further information by product in this report is only available behind a paywall. Of course, these values reflect the total market for both embolization and occlusion devices as well as consumable products. As these devices are not exclusively used for treating liver cancer, it is consequently not possible to derive an average cost per patient directly from this recent market size data.
As such, I searched for older numbers that could allow me to determine the value of embolization consumable products. Per an earlier version of the Millennium report, in 2011 embolization particles were projected to grow significantly through 2015. Radio-embolization was valued at $50 million globally and projected to grow to $128 million in 2015 at a 26.49% C.A.G.R. "Drug-eluting beads" were valued at $11 million and projected to grow to $28 million at at 26.31% C.A.G.R in the same period.
Applying the same C.A.G.R.'s to 2016 yields the following values: around $162 million for radio-embolization and $35 million for drug-eluting beads or $197 million total.
Assuming that North America and Europe also comprise 54% of these two sub-markets, those values decrease to $87.48 million for radio-embolization and $18.9 million for drug-eluting beads for the two regions together or $106.38 million total.
WORKING IN PATIENTS
The 2011 Millennium Research report other sources emphasize that radio-embolization and drug-eluting beads are specifically used for treating liver cancer. While these products may also be used to treat other conditions, based on these sources it is reasonable to assume that they are most often used to treat liver cancer.
Each year 39,230 people are diagnosed with liver cancer in the U.S. (and 27,170 die from the disease annually). Meanwhile, liver cancer is the "14th most common cancer" in Europe where around 63,500 new cases are diagnosed each year. 90,670 people between the two regions are diagnosed with liver cancer each year. I was unable to find a statistic of how many people in both regions currently have liver cancer, but it is a vicious disease with a 44% survival rate in the first year and embolization has been proven to reduce the two year mortality rate, meaning that acting quickly is crucial.
Of those cases, 75% of people are diagnosed with inoperable cancer and so are candidates for embolization which has been established as an effective means of treating "unresectable tumors." This means that around 68,000 of newly diagnosed people are candidates for the treatment per year.
I was unable to find statistics on the average number of times patients can receive the embolization treatments per year, but I did find that the benefits of chemo-embolization last an average of 10-14 months, or about a year, implying that patients can receive it once a year.
Similarly, I was unable to find the average number of liver cancer patients in North America and Europe who undergo this treatment annually, but can settle on a rough range based on some assumptions:
1) Not all of the 68,000 people diagnosed in a year who are also candidates for embolization will undergo the treatment.
2) BUT, that group of 68,000 people is less than the total number of liver cancer patients, because it only considered new diagnoses and patients can receive the treatment multiple times.
If all 68,000 newly-diagnosed people in North America and Europe (but no prior year diagnoses) receive one radio-embolization or drug-eluting beads treatment, the annual cost per patient would be:
$103.38 million / 68,000 = $1,593 per person across both regions
If only half of the 68,000 newly-diagnosed people in North America and Europe (and no prior year diagnoses) receive one radio-embolization or drug-eluting beads treatment, the annual cost per patient would be:
$103.38 million / 68,000 = $3,040 per person across both regions
Using market size, patient data, and some admittedly rough assumptions, I guesstimate that per-patient cost of radio-embolization or drug-eluting beads is between $1,593 - $3,040 per patient in the United States (using regional data for North America and Europe).
Note, the total market size for drug-eluting beads is significantly less than that of the radio-embolization market, but I was unable to determine how many people use one vs. the other product. As such, it is not possible to accurately determine the cost of each separately. It could be that drug-eluting beads are cheaper, as total market size is less, but without knowing the number of patients using them, it is not possible to verify that hypothesis.
ESTIMATING A PERCENTAGE
SIR-spheres are a type of radio-embolization treatment that, based on the Medicare Payment Schedule mentioned earlier, cost $6,593 - $10,151 to be administered. I established earlier that the cost of the micro-spheres themselves should be a percentage within that range. The range I settled on through market sizing and patient data meets that important requirement and represent between 15% - 46% of administration depending on which estimate ($1,593 - $3,040) and total cost ($6,593 - $10,151) are used.
POSSIBLE CONTINUED RESEARCH
In understanding what types of information are and are not publicly available on this topic, I’ve suggested a few other routes you may be interested in researching:
1) While price information is lacking, marketing information on each product is quite plentiful. You may be interested in learning which are considered most cost effective or in completing a competitive analysis to learn more about each one.
2) If you are interested in learning more about trends and the future of these products, you could request a list of academic or scientific sources that detail such information
3) As you had a few requests on this topic, you may be interested in researching the market size of the microwave ablation antenna or intra-arterial chemotherapy catheters either to understand the total market size or to make similar estimates as to per-patient cost.
To wrap it up, after searching extensively through product websites, product catalogs, industry reports, scientific articles, and government sources, a direct answer to your question is not publicly available because manufacturers keep pricing of medical devices and associated consumable products confidential. . However I learned about total costs of microsphere administration and made some rough estimates of the per patient cost of radio-embolization/drug eluting beads based on market size and general patient data.
If you’d like to continue research on any of the other topics I’ve outlined above, just let us know! Thanks for using Wonder!
A) Drug-eluting beads
- Tandem® (CeloNova Biosciences Inc., USA),
- DC-Beads® (BTG, UK)
- HepaSphere® (BioSphere Medical, Inc., USA).
- Note 1: I found that DC-Beads and hepasphere are not available in the U.S.
- Note 2: TANDEM Microspheres are apparently more cost effective than other products because they can deliver more in one dose, are easier to use, and provide a more controlled drug release.
B) Radioembolization microspheres
- SIR-Spheres® (Sirtex Medical Limited, Australia)
- TheraSphere® (BTG, UK).
C) Non-drug eluting, non-radio PVA (Cook, Bloomington, USA),
- Contour SE® particles (Boston Scientific, Natick, USA)
- Bead Block® (BTG, Surrey UK). DC/LC Bead® (BTG, Surrey UK)
- Embosphere® is a spherical embolic agent marketed by Merit Medical (Rockland, MA, USA)
- Embozene® (CeloNova BioSciences Inc., Atlanta, GA, USA)