The Cancer Society has called for an early-access scheme, and Labour's previous health spokeswoman Annette King repeatedly called for one, saying that when in Government Labour would look at what funding was needed.
New Health Minister David Clark told the Herald the Government wanted to explore how such a scheme could operate.
The United States and Britain have versions of early-access schemes to let certain patients access ground-breaking drugs.There is a real problem with funding of these schemes for very expensive treatments. While these treatments may be effective and have highly positive outcomes for the patients that receive them, focusing on the patients who will receive the treatment ignores the opportunity costs (this is a point I have made before about Pharmac funding, here and here). The appropriate way to decide on which treatments are funded is by considering their cost-effectiveness, not by considering which treatments generate the most negative media attention for the government.
A focus on cost-effectiveness ensures that scarce healthcare resources are being used where they will generate the greatest benefit for society. A treatment is cost-effective if it increases a person's health at a lower cost than alternative treatments. Since not all treatments provide the same health benefits (and many have negative side effects, etc.), we need some way of consistently measuring the health gains from a treatment, and measuring the cost per unit of health gain. To do this, we could use Quality-Adjusted Life Years (QALYs - a measure that combines length of life and quality of life) as our measure of health gain, [*] and cost-per-QALY-gained as a measure of which treatments are most cost-effective. A treatment that provides the same increase in QALYs for lower cost, or more QALYs for the same cost, should be preferred for funding.
That might sound unfair (especially to patients who miss out on funding, or their family or friends), but the alternative is even more unfair. If we ignore cost-effectiveness and simply fund any treatment that generates negative media attention (within the same fixed budget), then the healthcare budget will generate a lower total improvement in health. Funding expensive and less-cost-effective treatments has serious costs in terms of decreases in overall health and wellbeing of the population.
Even if the government increases funding for Pharmac, that increased funding should not necessarily go to these next-generation treatments, as there may be other currently-unfunded treatments that are most cost-effective and those should be funded first. Indeed, funds for next-generation treatments are not necessarily a good thing, as the Herald article notes:
The Cancer Drugs Fund in the UK has been overspending despite budget increases, resulting in a number of treatments being taken off its list.
An analysis in the leading cancer journal Annals of Oncology found the medicine funded through the British scheme was not worth the money, as only 18 of the 47 treatments prolonged the patient's life.
One of the paper's authors, Professor Richard Sullivan of King's College London, said the fund had been a "massive health error", and the populism that drives public policy has no place in health.We need to be careful that our healthcare decision-making is made on the basis of what will generate the greatest gains in health for the budgeted amount, rather than making populist decisions that will make us worse off.
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[*] An alternative is to measure health using the number of Disability-Adjusted Life Years (DALYs) averted. DALYs are a measure of health lost due to illness or injury, which can be used in place of QALYs (you can read more about QALYs and DALYs here).
