Det var noen reimbursmentproblemer med Zevalin som også dempet salget:
''Those kind of blunders were minor compared to the nightmares of reimbursement. Bexxar’s original wholesale price was set at $26,000, which sounded expensive to a lot of people a decade ago (although it looks like a bargain by cancer drug standards today). Younes said he didn’t recall any problems with reimbursement for Bexxar at his previous institution, MD Anderson Cancer Center in Houston, TX. But there were complaints from other physicians that they weren’t getting enough money from Medicare to justify prescribing the drug.
Reliable data on pricing and reimbursement are always hard to come by, and it was further complicated in this case because of variations from place to place. But in 2007, a radiologist at Northwestern Memorial Hospital in Chicago, Gary Dillehay, did a survey on the radioimmunotherapies for the Society of Nuclear Medicine. He found that Zevalin typically cost hospitals $22,000 to $24,000. Medicare, at that time, said it planned to reimburse hospitals $21,850 for a course of Zevalin and even less for Bexxar. Corixa, unable to turn Bexxar into a profit center, ended up being acquired by GlaxoSmithKline in 2005.’’
Så bare Betalutin får en bedre reimbursment ordning i 3 FL har de allerede en fordel i forhold til hva Zevalin/Brexxar hadde i sin tid.
Så klinikker hadde kanskje problemer med å få tilbakebetalt alle pengene hvis de brukte Zevalin som ‘‘consolidation’’ etter første linje behandeling. Så lenge Betalutin ikke er godkjent i kombinasjonen med førstelinje, får de heller ikke reimbursment for evt. off-label bruk. Jeg beklager, og vil nødig ta fra deg din herlige optimisme, men jeg tror personlig ikke det kommer til å bli en utstrakt off-label use i denne indikasjon. Men det vil tiden vise!