How should we value the innovative cancer medicines that are transforming patient outcomes?
28.03.19
A blog by Nathalie Moll, EFPIA Director General
A recent WHO technical report on the pricing of cancer medicines has sparked a lively debate on oncology spending and access to life-changing therapies. While we have fundamental concerns about the approach taken in the report, and the conclusions the authors reached, it offers opportunities for some fresh thinking on the future of cancer care.
A recent WHO technical report on the pricing of cancer medicines has sparked a lively debate on oncology spending and access to life-changing therapies. While we have fundamental concerns about the approach taken in the report, and the conclusions the authors reached, it offers opportunities for some fresh thinking on the future of cancer care.
The report touches on some of the advances in cancer care we have witnessed in recent decades. However, the focus is primarily on the cost of these new treatments. The report suggests that the rate of expenditure on cancer medicines is much higher than the rate of newly-diagnosed cancer cases, and higher than overall healthcare inflation. It attributes this, in part, to ‘increases in medicines prices or a shift towards higher-cost cancer medicines’. At the same time, the report expresses concerns about access to essential cancer treatments.
To put this in some context, consider the fact that spending on cancer drugs accounts for just 1% of the yearly expenditure on medicines in the US and Europe. If we look at spending on cancer alone, cancer medicines account for about 25% of the total cancer care expenditure. Health spending on cancer as a share of total health expenditure has been stable at around 6% of total healthcare expenditure on average in the EU between 1995 and 2014 despite the growing incidence and relative burden of cancer(1).
Most of the medicines prescribed by doctors to cancer patients around the world are not the breakthrough therapies that might come to mind when we discuss the price of new treatments. It can be tempting to look at the price tag of an innovative medicine and conclude that they are a threat to the financial stability of national healthcare systems, but it does not reflect the financial reality of cancer care.
Nor does it follow that the price of the latest medicines is the key barrier to accessing care. Governments in most countries have a range of tools at their disposal to help improve access to innovative drugs. For example, establishing dedicated cancer care funds either within the national health budget, the health insurance system, or as a new part of health budgets.
We recognise the affordability challenges that our healthcare systems face from ageing populations and increased prevalence of chronic diseases, including cancer. This is a shared problem that we must solve together.
Applying a ‘cost of goods’ methodology to inform pricing completely fails to reflect the reality of researching, developing and delivering new cancer medicines for patients. Breakthrough therapies are the result of decades of research into the mechanism of disease, the laborious hunt for biomarkers and the test thousands of molecules in the search for new treatments. For every 10,000 molecules tested by scientists, only one will be successful.
The cost of developing a single therapy must include the cost of all the setbacks and blind alleys that are part of drug development. This is reflected in the prices of new cancer medicines in Europe that are negotiated with governments.
In finding a price that incentivises innovation and reflects the value of addressing unmet need, medicines are subjected to rigorous value assessments that compare their clinical and cost-effectiveness against existing treatment options.
A bright future
Enormous advances have been made in cancer care in Europe and the future looks brighter still. First, let’s take a step back to look at where we are and how far we’ve come together. Great strides have been made in improving outcomes for people with cancer. Think of the many Europeans diagnosed with cancer in recent years – the chances are you will know of them personally. Over 66,000 more people diagnosed in 2012 will live beyond five years than was the case just a decade before. Death rates from cancer have been declining over time.
New medicines have a played a vital role in this significant progress, helping to transform many cancers into manageable chronic conditions. For some cancers, where five-year survival rates were truly awful, patients now have hope where previously there was none. Take lung cancer for example. Between 1996 and 2016, the number of treatments available to patients with lung cancer increased from four to 19 and new diagnostic tools are helping get the most from these medicines.
In other cancers, modern treatments have addressed quality of life issues that matter to patients. We now have therapies with fewer side effects, offering shorter hospital stays and more time at home or in the community. New treatment choices and growing volumes of outcomes data are empowering clinicians and patients with an unprecedented level of knowledge and choice.
Exciting new treatments, such as combination therapies, pan-tumour treatments and CAR-Ts, could unlock fresh advances in cancer care. Of course, there is still much work to do, which is why researchers in industry and academia continue to search for new ways to beat cancer and improve lives.
These breakthroughs come at a time when many governments are seeking to contain or reduce healthcare spending. We need to work with partners to create a system that rewards and drives better cancer outcomes – moving away from interventions that are not delivering for patients.
Advances in data science and outcome measurement can help. By collecting and analysing clinical and patient-reported outcomes, we can devise new models to can improve the value we deliver to all stakeholders in the health care system.
While our scientists, doctors and patients push the boundaries of medical science, it is crucial that we have evidence-based conversations about how to bring evidence-based medicines to those who need them.
Reference
(1) IHE Report: Comparator Report on Patient Access to Cancer Medicines in Europe Revisited (2016) https://www.efpia.eu/media/412110/ihe-report-2016_4_.pdf
