There has been an alarming upward trend in
the costs of similar treatments, as more drugs are developed and come on to the
market, new Pharmac
figures show.
And as
the price of life-saving medicines soar and pharmaceutical companies
show no signs of justifying their costs, the Government is warning that
something has got to give.
Pharmac, the Government's drug buying
agency, began funding a key blood cancer
drug Thalidomide, manufactured by drug giant Celgene, in 2002. While the true
costs of what Pharmac pays are confidential, the list price for the drug in
2002 was $360, based on a daily average dose for a month.
Compare
that with a later iteration of the same drug - Lenalidomide - which in 2014
carried a list price of $8353. A third option for blood cancer patients, whose
condition might not respond so well to the first two, was Bortezomib, which had
a list price of $9742.
The
benefits of treating cancer with any of the drugs were similar, and limited
studies comparing Lenalidomide and Thalidomide showed no survival difference.
When
it came to differing forms of chemotherapy for breast cancer, list prices had
risen 443 per cent.
Anthracycline,
a common chemotherapy, was listed at $975 in 2002. As two more options came
onto the market - Docetaxel, also in 2002, and Trastuzumab, in 2007 - list
prices rose to $2488 and $5300 respectively.
A
similar trend was also shown across medicines for the treatment of kidney
cancer, and lung cancer, rising 411 and 44 per cent respectively.
While
all those costs related to the list-price of the medicines, chief executive
Steffan Crauzas said Pharmac did not pay that much.
How
much less Pharmac paid was confidential, but the increase in the list-price
showed an alarming trend that the overall cost of providing New Zealanders
access to medicines was becoming more difficult.
Costs
were symptomatic of a price-war raging overseas, where the medicines market was
not so tightly controlled by a public purchaser.
According
to the World Health Organisation, medicines
accounted for over half of total health expenditures and were often
"unavailable and unaffordable to consumers who need them".
It
recommended making some essential medicines exempt from taxation.
Breast
Cancer Aotearoa Coalition chair Libby Burgess, who led a campaign for the
public funding of breast cancer drug Herceptin, said the problem was the
Pharmac model.
She
cited Australia, where two separate bodies took care of funding decisions and
then purchase of the medicines respectively.
"All
of that happens under one roof in Pharmac, which means its very easy for one
part of the process to compromise another."
"There's
been a lot of criticism of Pharmac over the years, and I was involved in
advocating for Herceptin, but I strongly believe now there needs to be a strong
focus on the costs that pharma are charging when they introduce new targeted
therapies into the market.
"We
certainly can't afford all of them and I think our process of carefully assessing
the drugs is a good one."
Associate
Health Minister Peter Dunne said Pharmaceutical companies needed to justify
their costs more.
"I
think that there's a real question about how everything starts with several
zeros behind it, and think that is a question mark... but it may not solve the
issue as far as access to medicines in New Zealand is concerned."
Instead,
it was Pharmac that would likely undergo changes in the next 10 to 15 years.
Those changes were unlikely to be the kind Burgess was after, however.
"Pharmac
are remarkably skillfull... and they are able to put these packages together,
which are impressive. But the issue I thought they would have done a little
more on, is actually evaluating their decisions; was there a benefit from funding
Herceptin, for instance?
"We
can be confident in the model at the moment, and in the forseeable future. But
that's not going to [last forever]." Dunne said.
"[Drug
companies] have got the upper hand, and they know it. At the end of the day, no
government is going to deny its citizens access to medicines."
