Pharmac anounces huge step forward in cancer drug-funding process – Dr Ruth Spearing


Last week the minister responsible for Pharmac David Seymour announced that the agency would be able to consider applications for funding of a drug at the same time as it is being considered by Medsafe.

This is a good step forward in speeding up the process of getting new cancer drugs to New Zealanders.

The Government has also promised that the top 13 drugs recommended for funding by the European Society for Medical Oncology will be funded.

This is also good progress but unfortunately this list did not include any drugs for patients with blood cancers, as the society has not yet reviewed these drugs.

This creates a real equity issue: an estimated 21,000 New Zealanders are currently living with blood cancer and every day eight children and adults in New Zealand are diagnosed with a blood cancer. The plight of many quite young patients living with myeloma has recently been highlighted and it is important that this group of patients is not overlooked.

Addressing this issue is one of many substantial reforms of Pharmac that are essential if New Zealand is to move towards having similar access to lifesaving medicines as other countries with a similar GDP per capita.

Thousands of patients suffering from blood cancer will not benefit from the new drugs.

One high priority for reform that is less well understood by the public is the negative impact the chronic underfunding and the lack of flexibility of Pharmac has had on New Zealand’s ability to take part in groundbreaking clinical trials.

New Zealand is so far behind the rest of the OECD countries that the “standard of care” drugs against which these new drugs are benchmarked in the trials are not funded, and so, sadly, these groundbreaking trials are now increasingly not offered to New Zealand.

Particularly important are clinician-initiated trials (as opposed to pharmaceutical company trials), as they will look not only at new drugs but also, for example, the use of new molecular or imaging techniques to assess response, enabling some treatment courses to be safely shortened, with fewer associated side-effects and less cost. On very rare occasions Pharmac has supported such trials.

As an example, Pharmac approved the District Health Boards purchasing a drug which enabled New Zealand to take part in an international trial for Acute Myeloid Leukaemia, run out of the United Kingdom.

This decision paid off very well, with the DHBs needing to undertake fewer highly expensive stem cell transplants, gaining $4.5 million of free, now FDA-approved drugs, $76,000 worth of free molecular testing, and the best outcomes for this devastating condition that New Zealand has ever had.

The outstanding return on investment on these types of trials is supported by independent studies such as the KPMG report into Australian clinical research which concluded clinician-initiated trials delivers outstanding return on investment with a $78 billion net gain to the Australian economy. One trial had a massive return of 6,465 per cent.

Why would any organisation or country not invest in and support health-related activities with such a return?

However, when the results and financial gains of the UK leukaemia trial were presented to the chief executive of Pharmac, Sarah Fitt, her reaction was “that isn’t something Pharmac will be doing again”. Sadly, as a result, that was the last of the UK Acute Myeloid Leukaemia trials that New Zealand has been able to offer patients.

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Support of these clinical trials is of paramount importance as they save lives – and money. It’s a win-win for all. Greater flexibility within Pharmac and within Health New Zealand to support national trials is essential.

Leaders from the Australasia’s leading blood cancer research group, the Australasian Leukaemia and Lymphoma Group, are gathering in Wellington next week to discuss clinical trials in NZ.

They will be making the case for these changes. It is to be hoped that, with vision and appreciation of both the health and economic value of clinical trials, the Government will seize the opportunity to support this critical pathway to improving life outcomes for New Zealand patients.

Dr Ruth Spearing, CNZM, is a haematologist and medical researcher for blood cancers