In December 2008 the new National Government decided to fund a 12-month course of Herceptin for women with early stage breast cancer, outside of the PHARMAC model.
PHARMAC’s Pharmacology and Therapeutic Advisory Committee had been unconvinced by the evidence for Herceptin’s efficacy and advised PHARMAC to fund a nine-week treatment course. There were also side-effects – serious heart problems that potentially affected a number of patients receiving Herceptin.
But worldwide, Herceptin was being spoken of in the media as a ‘wonder drug’ and breast cancer advocacy groups had mounted a sustained campaign for it to be funded.
Rarely in the history of PHARMAC had a medicines funding decision become so politicised, as National, then in opposition, during the 2008 election campaign promised to make 12 months of Herceptin treatment available. But the controversy was not without precedent.
On coming to power in 1999, the previous Labour Government had directed the Health Funding Authority to instruct PHARMAC’s Board to fund beta-interferon drugs for the treatment of multiple sclerosis.
“When they came in, the first thing I did was go and meet with Health Minister Annette King, and handed her the documents. All she needed to do was sign them,” says Wayne McNee.
“After that, there was a queue out the door – ‘fund my drug’. She learned pretty quickly that if she wanted to take over the management of funding of pharmaceuticals she could keep on directing us.”
Funding of Herceptin generated a whole different level of public debate in early 2008. But internally, PHARMAC’s experts held their nerve. They remained unconvinced that a longer course of Herceptin, which cost up to $100,000 including administration costs, would deliver any greater benefits than the nine-week treatment. The opportunity cost would be huge.
PHARMAC also contributed to the international literature on Herceptin. In a paper published in The Lancet in May 2008, leading New Zealand health experts and PHARMAC staff, including future chief executive Steffan Crausaz, expressed concern that Herceptin was being talked up as an effective medicine despite incomplete clinical trial data being published.
“Failing to publish inconclusive results can mean wide (and wasteful) use of ineffective treatments, or even unnecessary illness and death if the
reported risks of harms are underestimated,” they wrote.
“Clearly adjuvant Herceptin is effective, but how best to use it appears to have been hampered by some publication choices that presently are unclear.”
This was PHARMAC following its Decision Criteria to the letter. Ultimately the Government funded the medicines directly through the Health Ministry.
PHARMAC assisted the Government, providing information to inform its negotiations with drug company Roche to procure Herceptin, which was not funded out of PHARMAC’s budget, but from another area of the health budget.
With the distance of a decade, PHARMAC’s senior management from that era remain satisfied they made the right decision.
“It’s a credit to PHARMAC that they were able to hold that line,” says former medical director Peter Moodie.
Indeed, Health Minister Jonathan Coleman admitted as much in 2015, as PHARMAC was considering whether to fund another cancer medicine – Keytruda.
“The research shows that nine weeks, which were funded previously, is actually just as good as 52 weeks, but I think lessons have been learned,” he told TV3’s Paul Henry show.
“You’re not a pharmacologist, you’re not a doctor: PHARMAC have the best possible advice and they’ve got to make the best decision in the interests of New Zealanders,” he added.
“PHARMAC have the best possible advice and they’ve got to make the best decision in the interests of New Zealanders.”
– Health Minister Jonathan Coleman
Despite its disagreement with the Government over Herceptin, PHARMAC remained open to funding longer duration regimes of the treatment - if stronger evidence for its medical eddicacy and cost effectiveness emerged.
In early 2007, just before it confirmed funding of the nine-week Herceptin regime, PHARMAC sought to cut through the uncertainty by supporting the international SOLD clinical trial, which sough to compare the effiacy of the twelve month and nine week treatment regimes.
The trial ran from 2007 to 2014 and included 2176 patients, 160 of them from New Zealand. By late 2017 the results were in - the two regimes were similarly effective, but there were reduced side effects, cost and inconvenience for patients on the nine-week regime.
Last updated: 13 September 2018