When drugs are not subsidised by the government, and a doctor feels that a drug would be worthwhile, another way of paying must be found. Some of these treatments are very expensive. In some cases, the patient has to cover the cost. It can be yet another difficult decision for a cancer patient to make.
A new study by CTC researchers and colleagues has examined these problems from the point of view of practising oncologists. They surveyed medical oncologists and oncology trainees in Australia and have reported the results from 154 respondents.
Almost all had discussed or prescribed an unfunded cancer drug, and 92% had discussed and 68% had prescribed one in the past 3 months. They were more likely to do this if the patient was considering palliative treatment or had already had other treatments. When unfunded cancer drugs were prescribed, their patients met the full cost about 30% of the time. On other occasions, pharmaceutical companies subsidised the cost of the drugs and less commonly health insurers, charities and hospitals did so.
The oncologists' main concerns were financial hardship to the patients and their families and the difficulty for patients of evaluating the benefits versus the costs. They also worried about not being able to offer the same treatments to all their patients and thought that asking patients to make these decisions is not fair. The typical cost they were looking at, after subsidies had been taken into account, was $7500, but it ranged up to $100,000. Oncologists thought that a website with a list of access programs would be useful.
Public funders have to work out whether a new drug is worth funding. In Australia, the Pharmaceutical Benefits Advisory Committee assesses new drugs for subsidy. They consider safety, effectiveness, cost-effectiveness, budget impact, the certainty of the evidence, and the degree of clinical need. Drugs may be subsidised if they improve survival or other important outcomes, such as quality of life. The most common reasons for not subsidising a drug are inadequate cost-effectiveness or if its price is too high.
CTC research is central to these issues. CTC has completed over 100 trials of treatments for cancer, aiming to provide evidence of their effects on survival, tumour responses, quality of life and other outcomes. Health economic evaluation, often carried out as part of a trial, then assesses whether a treatment benefit is worthwhile taking into account its costs.
A previous CTC study analysed costs to government of anticancer drugs. They found that costs through the Pharmaceutical Benefits Scheme rose from $65 million in 2000 to $466 million in 2012. The contribution of anticancer drug costs to total expenditure more than doubled during that time.
10 August 2017