Evidence-based approach to funding choices more important than ever
10 October 2018
Cancer will affect almost all New Zealanders at some point in their lives. Given the range of new treatments in the pipeline, PHARMAC works hard to fund the best medicines it can based on the evidence, says Sarah Fitt, Chief Executive.
We all know someone who is, or might be, affected by some form of illness. PHARMAC recognises this is a significant issue for many people, and is acutely aware of their concerns, especially about access to new cancer medicines.
New medicines are constantly being developed, and these are often high-cost. Drug companies often claim their new medicine is significantly better than earlier treatments. This makes PHARMAC’s evidence-based approach to making choices about medicines funding more important than ever. Our job is to assess the evidence and see if the claims stack up.
Although many new medicines look promising initially, unfortunately they don’t always provide long-term patient benefits. A study in the Journal of the American Medical Association(external link) found that, of 36 cancer medicines approved in the US between 2008 and 2012, only 5 improved people’s survival rates compared with existing treatments or placebo when reviewed four years later.
The study underlined the significant risks around making decisions based on early data on effectiveness of cancer medicines. The fact is, funding medicines early can lead to lost opportunities to improve health for other patients who may miss out on other treatments or services.
Other research(external link), by the University of York, came to a similar conclusion about the United Kingdom’s Cancer Drugs Fund, which was established to pay for cancer medicines beyond the NHS’s reach. The research found that, due to the fund’s failure to attract effective and inexpensive medicines, greater health improvements could have been possible had the money been made available elsewhere in the NHS.
When PHARMAC considers a funding application for a new medicine, we use expert clinical advisors with the relevant knowledge to critically assess the evidence and help us make the right decision. This can take time, and we fully appreciate that many people don’t have time on their side. It’s a difficult balancing act, taking that into account alongside other factors like how much we have to spend and what other medicines are waiting to be funded.
Where PHARMAC see significant benefits from a new medicine, we move quickly to fund it. This was the case for Opdivo (nivolumab), an innovative melanoma drug funded in 2016 just months after initial discussions with the company that supplies it. And New Zealand was one of the first countries in the world to fund Truvada to prevent HIV infection, a decision we made earlier this year.
Australia is often cited as a place that funds medicines that aren’t available here. However, unlike other countries such as Australia, PHARMAC works within a fixed budget. We need confidence we’re making the right decision and are spending our $985 million budget responsibly on medicines that are proven to make a meaningful difference for patients.
Our evidence-based decision-making approach benefits more New Zealanders every year. For example, the number of people receiving funded cancer medicines has increased by 50 percent since 2011. Over that time, PHARMAC has added 17 new cancer medicines, and widened subsidised access to 13 others, including medicines for breast, prostate, lung, kidney, brain and colon cancers.
Overall, PHARMAC has doubled the spend on cancer medicines to just over $200 million since 2011, 17 percent of the total budget. A quarter of this was on just two medicines – Herceptin (for breast cancer) and Keytruda (for melanoma). This reflects the very high cost of some of these treatments.
PHARMAC will continue making the best choices we can, expanding available treatments for all New Zealanders based on a robust, evidence-based approach, just as we have done for the last 25 years. We know funded access to effective medicines is important to everyone – it’s important to us too because we strive to get the best health outcomes for all New Zealanders from the medicines we fund in a fair and equitable way.
Last updated: 10 October 2018