Sticker Shock

Last Wednesday, when I offered up my vein for the third chemo cycle, I arrived at the 50 percent point in my treatment. Following the same orders he prescribed after my second cycle, the oncologist again instructed me to return the next day for an injection of Neulasta, a drug that stimulates the bone marrow to make white blood cells and thus prevents infection.

This time, however, before I arrived for my dose of Neulasta, I received an astonishing phone call from the hospital. An insurance person was calling, as a courtesy, to clue me in on Neulasta's price tag.

I should say that three weeks earlier, after receiving my first dose of Neulasta, I thought to myself that the drug racing to my bone marrow had to be on the pricey side. After all, Neulasta has an important and specialized job, and it seems to keep working at its assigned task for the duration of the three-week chemo cycle. Both smart AND highly focused, all in a single dose -- these attributes don't come cheap.

Idly considering what such a drug might cost, I reasoned that about 18 months earlier, I had paid a little more than $100 for an inoculation for my son, Joe, to prevent him from contracting meningitis in the college dorms. Given that the meningitis vaccine's price must be at least partially set by its volume distribution to students nationwide and given that cancer is generally a big-ticket disease, I assumed Neulasta fell into a much higher price bracket. I was guessing that it hovered in the $400 per dose range.

Imagine my surprise when the woman on the phone calmly stated that Neulasta cost $1200. Startled, I said, "For the series?" I was quickly doing some mental arithmetic and figured that if I received three Neulasta doses, each worth $400, my bill would total $1200. "No," she said, "Apiece."

So, I'm now the proud purchaser of $2400 worth of Neulasta, and since I'm still due for one more chemo cycle, my tab for this drug is likely to reach $3600 before March is over. This sticker-shock scenario raises so many questions about universal health care and the pharmaceutical industry and the insurance companies that they furrow my normally untroubled brow. But wait. Don't we pay elected officials to grapple with these conundrums?

Not to worry about me personally, though. I'm one of the fortunate sick people who has health insurance. By receiving a designer drug, I've done nothing more than guarantee that I'll meet my shockingly high deductible sooner in the calendar year rather than later.

The situation does cry out for a cost-benefit analysis, however. On the benefit side, Neulasta did impart some good effects. I felt better overall during the second chemo cycle than the first one. Presumably, my good phase was due to the addition of Neulasta, which quietly urged the growth of white blood cells. Moreover, should I have not taken the drug and developed an infection, a hospital stay would have been far more expensive than the total cost of the Neulasta injections. Cost-benefit analysis: Probably worth it.

Anyway, it's too late to be counting hundreds now. Combating a serious disease is -- at least in this way -- similar to finding yourself tired and hungry, but the only available restaurant is a posh one. You look at a menu, and you're aghast at the prices. But you really have no choice, except to order. You need food, and now is not the time to quibble over the cost of an entree.

One more thought, Amgen, which manufactures Neulasta, is a Southern California company, based in Thousand Oaks. At least I'm buying local.