Access to drugs a costly dilemma
Access to health care can be a political and economic decision, as much as a medical one. Unmet need is rife within the public health system, high burnout rates are being recorded among medical staff, and – reportedly – most of the country’s district health boards are operating in the red, to the tune of $54 million of DHB debt overall, nationwide. Hardly an ideal backdrop as New Zealand assesses its ability to purchase the new generation of ultra-expensive ‘biologics’ drugs, which are coming to market just as the baby boomer generation hits the age brackets associated with an increased risk of cancer.
The new anti-cancer drugs – Keytruda and Opdivo have become household names – cost well into six figures per patient annually. Earlier this year, patients with melanomas campaigned publicly for access to these drugs. Eventually, Pharmac (and the ministers holding the purse strings) decided to provide state funding only to those patients with advanced skin cancer.
Last week, lung cancer patients found themselves in exactly the same position, of having to mount a very public – and highly political – campaign to qualify for similar state funding of their treatments. Meanwhile, equally expensive drugs (and stem cell treatments) for multiple sclerosis are hovering on the horizon.
All these drugs offer life changing – and in some cases, life saving – relief to people in desperate need. Pharmac is the meat in the sandwich, caught between rising public demand for sky-high expensive treatments on one hand, and Beehive-driven demands for frugality on the other. Given the rising curve of demand, the funding increase for Pharmac in this year’s Budget looks like a drop in the bucket. Also, it doesn’t help Pharmac’s ability to make coherent decisions that the test results for the new drugs are still pouring in.
Should these ‘biologic’ drugs be used as first response treatments in isolation, or should they be used in tandem with other drugs, later in the illness cycle?
As things stand, and to repeat ... people with advanced skin cancer now qualify for state funding for these drugs, while lung cancer patients currently do not.
No good medical reason exists for that distinction, only the political desire to limit the cost.
In future, this situation looks like becoming a major problem for governments of the left and right. Drug companies argue that the products they provide are in the public interest.
In practice, the main interest they seem to demonstrate is one of testing the price limits of whatever the public – and its elected representatives – will bear.
For every year a cancer drug added to a US patient’s life in 1995, the cost was $US54,100. That cost had reached $US207,000 in 2013. Plainly, the cost of buying one more year of life from the pharmaceutical companies is rising far faster than the inflation rate – and the politicians will need to address the funding implications for Pharmac.