A diagnosis of cancer is a highly emotional experience. It is one that creates fear among the public as it can often be fatal, undetected and affects young and old alike. Countries like the UK and Malta that offer free medical treatment to their citizens struggle to keep up with the spiralling cost of cancer care as the incidence of the disease escalates with an ageing population.
In a world of finite budgets, difficult decisions have to be made by the health authorities, oncologists as well as NGOs in the context of the rapidly escalating cost of cancer treatment.
The financing model of free public health services is no longer fit for purpose. Add to this the increasing incidence of dementia and cancer and one can understand that countries offering free healthcare are facing formidable challenges. This is exacerbated by the high expectations of ordinary people who feel that they are entitled to be given the latest drugs when they are affected directly by cancer.
People expect some hard talk on the realities that treating cancer patients involves. However hard it is to accept, strict standards of ‘demonstrated cost-effectiveness on new therapies’ have to be defined if we are to support cancer patients with fairness.
We need to learn from the experiences of others. The UK NHS has many similarities to our own public health system. In 2010 the Conservative Party pledged to the electorate that it would enable cancer patients to get access to the latest drugs that the pharmaceuticals industry was churning out. The new conservative government set up the Cancer Drugs Fund to circumvent the tough guidelines used by the NHS to include new drugs on the free medicine register.
The CDF inherently undermined the guiding principle of the UK system – do the most good with the money you have. Critics of the CDF claim that it “undermines the entire concept of a rational and evidence-based approach to the allocation of finite healthcare resources and that the system is already bankrupt”.
The pharmaceutical industry is also failing miserably
But the chief executive of Breast Cancer Now, Baroness Delyth Morgan, disagrees. She argues that CDF “had a totally transformational impact on many living with incurable breast cancer”. Relatives of terminally ill patients understandably insist that on one can put a value on saving somebody or extending somebody’s life.
Unfortunately, some politicians resort to announcing populist strategies to appease distressed cancer patients and their relatives. But lead researcher Richard Sullivan from King’s College London argues: “Populism doesn’t work when you are dealing with complex areas of medical policy. When CDF was launched it was not monitored properly. It was politically and intellectually lazy.”
It is not just politicians who are to blame for the present limbo that cancer patients often find themselves in when seeking support to buy expensive drugs to treat themselves. The pharmaceutical industry is also failing miserably. When the UK government recently delisted a number of cancer drugs from the register of medicine that CDF provided for free to cancer patients, many pharmaceutical firms protested vociferously.
Many argue that the pharmaceutical industry is as much at fault in not making new drugs available to those who need them. They justify the high pricing of new drugs to the expenses incurred in research until one successful drug is approved by the US food and Drug Administration. A cycle of cancer treatment with one of the new drugs like Kadcyla can cost €100,000, if not even more. Very few people can afford such costs.
A spokesperson for Roche, a Swiss pharmaceutical firm, argues: “If we want to continue the rapid scientific progress of recent years in the most difficult-to-treat diseases, then we need to be prepared to fund this high risk model of drug discovery.”
The local system of making new expensive drugs available to cancer and other long-term ill patients is not fit for purpose. Too much reliance is made on charity NGOs who are faced with requests for help when the public health authorities fail to provide a solution.
Health authorities need to engage in an honest debate that will hopefully lead to prioritising the allocation of limited public funds to cancer care. The public also needs to be kept informed about the limitations that a free public health system faces when cost overruns are incurred year after year.
Political pressure at EU level is also needed to influence the pricing policies of pharmaceutical companies that are less than transparent in pricing new drugs.
johncassarwhite@yahoo.com