Healthy Skepticism Library item: 1984

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Publication type: news

Chandler J.
New medicines that can treat killer diseases are posing a giant dilemma
The Age (Melbourne) 2005 Aug 5
http://theage.com.au/articles/2005/08/05/1123125906327.html

Keywords:
Herceptin Avastin Erbitux Tarceva cancer

Notes:

Ralph Faggotter’s Comments: This interesting article highlights some looming dilemas in health funding. There are several new drugs which can slow the rate of cancer spread – but they are very expensive. This creates a dilema, even for wealthy countries. Is this a worthwhile use of health dollars? Or, as one cancer expert suggests – “It’s up to us to be
responsible – not to use (these drugs) as expensive pre-embalming juice.”

Full text:

New medicines that can treat killer diseases are posing a giant dilemma,
reports Jo Chandler.
http://theage.com.au/articles/2005/08/05/1123125906327.html

A NEW class of blockbuster cancer drugs is spilling out of the pipeline
of clinical trials and threatening to overwhelm Australia’s escalating
pharmaceutical budget.

Drugs such as Herceptin for breast cancer, Avastin and Erbitux for bowel
cancer, Tarceva for lung cancer and Glivec for leukaemia are extending
lives and may one day save lives.

But the new “biologicals”, as they are called – they use genetic
information to slow or stop the spread of cancers – are hugely
expensive, costing up to $60,000 per patient for a course of treatment.
And for that money patients are not yet buying a cure – just time.

Given the political pressure to rein in the national drugs bill,
tensions over what patients and doctors want and what the nation says it
can afford, are approaching boiling point, doctors say, and the
promising new cancer drugs are at the centre of the debate.

“The one thing I know for sure is that I am already sitting with
patients and families who have problems this new biology can address,”
says Professor Richard Bell, senior clinical adviser for the Cancer
Council of Victoria and director of cancer services at Geelong Hospital.

“I know some of these drugs work better, but they can’t have them. Is
Australia a shipwreck – is it a case of women and children only?

“What is rationing of health services – in reality, it is the deliberate
withholding of a treatment for economic reasons.”

For years, Australia’s drug evaluators have weighed the cost versus
benefit of new therapies in deciding which will be granted taxpayer
support. But Productivity Commissioner Helen Owens said recently: “We’re
on the brink of a revolution. We need to think about how we’re going to
handle it … how we’re going to pay for it.”

Hard choices about how much taxpayers are prepared to pay to prolong
life, and at what odds, are unavoidable. “These are difficult decisions
to make,” says Professor Lloyd Sansom, the chairman of Australia’s
principal drugs gatekeeper, the Pharmaceutical Benefits Advisory
Committee. “Are we selling hope or therapeutics?”

An adjustment at the gates, when there is high prevalence of disease,
could see the nation’s $6 billion annual pharmaceutical bill quickly
become $12 billion, he says.

“What do people expect, and what are they prepared to pay for?” he asks.
“It’s for society to debate.”

Professor Sansom kicked off the conversation with a round of talks with
cancer specialists that began in Adelaide last week. The issue will also
likely dominate a meeting of oncologists in Hobart next week.

Stoking the debate is the imminent publication in the New England
Journal of Medicine of promising new studies on Herceptin as a treatment
for early breast cancer, and an anticipated surge in demand for the
controversial $66,000 a year treatment.

Then there’s the decision by pharmaceutical giant Roche not to apply for
public subsidy in Australia for one of its hottest properties, Avastin.
Roche told The Age it was not seeking PBS listing for the drug at this
stage because at more than $50,000 a patient to achieve an average extra
five months of life, it is doomed to fail the committee’s tight
cost-benefit calculations.

We’ve arrived at the moment specialists and patients have dreamed of and
the money managers have long feared, says clinical director at
Melbourne’s Peter Mac cancer clinic, Professor John Zalcberg. We have
new drugs that are effective, expensive, and tackling diseases that
affect lots of people.

Professor Sansom says there is no one value applied to buying an extra
year of life, though observers say subsidies tend to vanish when the
cost pushes above $50,000. Instead, his committee evaluates drugs
against factors aimed at measuring overall cost benefit.

The committee has allowed subsidies of drugs for rarer conditions
costing up to $70,000. But in a common disease such as bowel cancer, a
drug costing $60,000 could easily cost the government $200 million to
$500 million annually, he says.

The question increasingly being asked in cancer circles is whether the
efforts to keep pharmaceutical costs in check have denied people access
to proven, viable treatments. Doctors’ ethical obligations to patients
are also preoccupying debate.

Last month The New York Times quoted a specialist from the Mayo Clinic
admitting that she did not tell poor patients about expensive therapies
because she did not want them to feel bad. “To me that’s unethical,
morally dodgy,” says Professor Bell. (He has worked as an adviser on
some of the drug trials.)

Professor Zalcberg says it is too early to conclude that people are
missing out on drugs they should have access to. There is a process of
evaluation that has served Australia well, he says. But it is true that
wealthy individuals in Australia are able to buy these drugs.

“My view is that government has a right to ration healthcare – to decide
where tax money is spent. But the community must be aware. The process
is not transparent,” he says. (Dr Zalcberg has also worked as an adviser
to drug companies on some of the trials.)

His colleague at Peter MacCallum, Professor Grant McArthur, says there
is increasing debate about the role of the oncologist.

“Our number one priority has to be the patients. But we also have to be
responsible to the community, so we do try to keep costs down,” he says.

Richard Bell says this obligation is keenly felt. “It’s up to us to be
responsible – not to use (these drugs) as expensive pre-embalming juice.”
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