Date: 28 Sep 2014
Topic: Bioethics, legal and economic issues
Lugano/Madrid, 28 September 2014 - Treatments for advanced cancer are often unavailable or available only at substantial out of pocket cost in many Eastern European countries compared to those in Western Europe, reveals an ESMO survey presented today at the ESMO 2014 Congress in Madrid, Spain. Optimistically, the study also shows that the discrepancies between Eastern and Western Europe are less for treatments that increase cure rates.
Oncologist Professor Nathan Cherny, chair of humanistic medicine at Shaare Zedek Medical Centre, Jerusalem, Israel, lead author of the study on behalf of ESMO, said: "The delivery of best cancer care requires availability and accessibility of the therapeutic agents needed to bring cancer under control."
Rolf A. Stahel, ESMO President, added: "The last number of years have seen a large number of new agents being developed and major improvements in outcomes over a range of different cancers but there is great heterogeneity in the availability of and accessibility to these medications across Europe. To address the issue of inequity in care we needed to map out what the problems are and where they occur."
The first results from the ESMO European Consortium Study on the Availability of Anti-neoplastic Medicines across Europe are presented today. For 13 major disease types the study collected information on what drugs were available, the out of pocket costs to the patient, and how accessible a medication was when patients had a prescription. It also investigated the administrative barriers, such as the requirement for pre-authorisation, that may interfere with patients' ability to access medications.
The study found big differences in cost, accessibility and availability of drugs between Eastern Europe and Western Europe. In many parts of Eastern Europe, drugs are either not available or are available only at great expense to the patient.
Cherny said: "These discrepancies are seen mainly in diseases where the treatments are highly dependent on new and expensive biological and chemotherapeutic agents. So for instance, for patients needing care for melanoma or for renal cell cancer, there are very few cheap medications that are effective. And the new therapeutic repertoire, which is much more effective than anything previously offered, is unaffordable or unavailable in many parts of Eastern Europe."
He added: "For diseases that are less dependent on expensive new therapeutic options – urothelial (bladder) cancer or cancer of the stomach, for example – these differences are much less substantial."
"Many of these new expensive medications don't cure patients but they help patients with advanced disease live longer and improve quality of life," continued Cherny. "Interestingly and importantly, expensive new medications that have been proven not only to help patients live longer but to improve cure rates --such as trastuzumab for adjuvant breast cancer or imatinib in the uncommon gastrointestinal stromal tumours (GIST)- are generally available and subsidised or reimbursed and we see this as a positive sign."
Commenting on the conclusions and implications of the study, Cherny said: "There is a mixed message here. The discrepancies are mainly in the setting of incurable cancers and are less for treatments which increase cure rates. We are interested in working with stakeholder to help reduce these discrepancies. A central part of this will be addressing the affordability of effective therapeutics, particularly for patients with advanced cancers that are not amenable to cure."
Dr Alexandru Eniu, head of the day hospital unit, Department of Breast Tumours, Chircuta Cancer Institute, Cluj-Napoca, Romania, study co-author on behalf of the ESMO Emerging Countries Committee, said: "It is concerning to see that patients in Europe with the same diagnosis have different accessibility to drugs. As the data show, for certain tumour types it certainly makes a difference which country you receive treatment in."
"There are two types of limitations," continued Eniu. "One is related to access to newer, more expensive drugs for which, depending on each country's budget, reimbursement might not be available. The second limitation is due to the fact that some old, inexpensive drugs that have been on the World Health Organization (WHO) Essential Medicines List for many years are still sometimes not accessible to patients in Europe due to drug shortage issues."
Commenting on ESMO's approach to tackling the problems identified by the study, Eniu said: "ESMO, as part of its official relations status partnership programme with the WHO, will analyse and provide data to the WHO regarding the availability of WHO essential medicines across Europe. This data will also include perceived causes for the medicine shortage, and provide solutions and recommendations for improving access to these essential medicines."
After presentation of the preliminary survey data at the ESMO 2014 Congress, these will be open to the public for an online peer review, where everyone (country reporters, medical professionals, the pharmaceutical industry, patient organizations, regulatory bodies, etc.) is welcome to give feedback.
Eniu concluded: "For the other drugs, ESMO is currently working on the Magnitude of Clinical Benefit Scale that will provide a way of prioritising, on a scale from 1 to 5, drugs/regimens used for a certain pathology. Once this instrument is available, a combined analysis is planned to understand which priority drugs are missing in certain countries and propose solutions adapted to the local situation."
Notes
Abstract 114IN - ESMO European consortium study on the availability of anti-neoplastic medicines across Europe
[1] More information about the ESMO anti-cancer medicines availability study and collaborators is available here: http://www.esmo.org/Policy/Anti-Cancer-Medicines-Study
Session info
114IN: Sunday, September 28, 2014 – 16:00 PM – 17:30 PM - Alicante