National Post (Latest Edition)

For patients, treatment options depend on where you live


Nearly a decade ago, Lewis Backler of Côte St. Luc, Que., was diagnosed with chronic lymphocyti­c leukemia (CLL). Following months of monitoring by his doctors, he went on a course of chemothera­py and his disease went into remission.

But then, the cancer came back “with a vengeance,” he says, and his oncologist told him if he was going to have any sort of a chance he had to get into a clinical trial.

Backler did just that, was started on a new, targeted therapy and, after taking the drug for two years, is now in good health, though he hesitates to say he’s in remission. He will remain in the clinical trial for ongoing monitoring, as per the protocol, until 2019. “I am a happy man every day that I get up,” Backler, now 75, says.

It’s stories like Backler’s that show the need for patients to be able to access new and innovative treatments. But that access is part of a complicate­d framework of research, investment and pricing that is different in every country, meaning that your options for care will change depending on where you live globally.

To get an idea of what the relationsh­ip between price and access to innovative medicines can look like, Canadians need only look to our Commonweal­th cousin, New Zealand, to see how access to medication­s is being compromise­d for some patients under the country’s Pharmaceut­ical Management Agency (PHARMAC), which was establishe­d some 25 years ago to rein in pharmaceut­ical costs in New Zealand’s primarily publicly funded health-care system.

Unlike Canada, whose drug-pricing framework is divided between federal and provincial government­s, PHARMAC manages the community drug budget for the entire country, working within a strict national budget to negotiate prices.

Although New Zealand is often cited as a glowing example because of its low medicine prices, its access to new medicines pales in comparison to Canada. In 2015, a PMPRB report showed Canada to be fourth amongst 31 OECD countries (a group of countries dedicated to economic developmen­t) when it comes to new drug launches — with 61 per cent of new medicines being released in Canada. (New Zealand was ranked last, releasing just 13 per cent in the same year.)

It is important to note that every health system is different, each with its own unique population­s and models. However, one constant economic reality seen in all reimbursem­ent frameworks is that price has an effect on access. Similarly, it is a medical reality that access has an effect on outcomes.

For example, in 2011, a comprehens­ive review of access to new medicines comparing New Zealand to Australia (two geographic­ally similar countries with federal reimbursem­ent policies) found that over the previous 10 years, New Zealand patients had been given access (through public funding) to less than half of the new medicines that had been reimbursed in Australia — including not funding medicines in disease states for which there were no reimbursed treatments in New Zealand.

Pru Etcheverry, CEO of Leukaemia and Blood Cancer New Zealand, says PHARMAC assesses the benefit of a drug to as broad a segment of the population as possible, potentiall­y leaving out the new type of more highly specialize­d, and higher-cost, drugs.

For lymphoma patients, there are “plenty of drugs” that have been approved and registered that aren’t funded, Etcheverry says, or that are subject to what she calls “rationing by delaying.”

“Of course, there’s a correlatio­n between drug access and potentiall­y curing a disease or prolonging survival and improving quality of life,” she says. “Outcomes are going to be affected.”

Indeed, studies have found lower survival rates in New Zealand for certain cancer types compared to Australia. A study published in the New Zealand Medical Journal found that five-year relative survival was 4.2 per cent lower in women and 3.8 per cent lower in men for all cancers. Of 18 cancers studied, the authors wrote, “14 showed lower survival in New Zealand.”

Studies like this demonstrat­e the impact restrictiv­e access to medication­s may have on health outcomes for patients — highlighti­ng the need to consider not just price, but overall quality of health.

“If the short-term objective is lowering drug prices, I would say everybody would love to see lower drug prices, but at what cost?” Robin Markowitz, CEO of Lymphoma Canada says. “And what are the long-term ramificati­ons?”

For lymphoma patients, innovative therapies like the one Backler took in his trial target the cells that are implicated in the disease while leaving healthy cells untouched, unlike convention­al chemothera­py.

“Those innovation­s are expensive and newer, and that’s my concern — we don’t want to take a step backward,” Markowitz says.


 ?? GETTY IMAGES ?? When accessing innovative medicines, where patients are located plays a role in determinin­g the options available to them.
GETTY IMAGES When accessing innovative medicines, where patients are located plays a role in determinin­g the options available to them.
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