Private healthcare patients get exclusive access to cancer drugs

steddyeddy · 15-04-2019 10:38am

Let's take a look at just one of the drugs, Tecentriq, a treatment for breast cancer. This has a 19% objective response rate (the percentage of patients whose cancer shrinks or disappears) for triple negative breast cancer. This is a form of breast cancer where three receptors such as the oestrogen and progesterone receptor aren't expressed. Since these receptors are often the target of conventional therapies for breast cancer this type of breast cancer is incredibly difficult to treat. Now we have a drug that can extend your life by 19%. I can't see how you can deny this to people.

steddyeddy · 15-04-2019 10:46am

Kurtosis wrote: »

OEJ, lifetime community rating was introduced in 2014, when the government's policy was to introduce universal health insurance. Since then, there's been cross-party agreement on the Sltecare strategy, to introduce universal health care and move away from the two tier system.

I don't think access and timeliness of access to health care should be based on ability to pay, rather it should be based on medical need. I think it is extremely unfair that money should allow one to jump the queue when it comes to medical treatment.

It's amazing how few people seem to agree with this statement. It seems people place more importance on a person's ability to pay rather than a system where another human's life may be extended. It's a really sick way of thinking.

One eyed Jack · 15-04-2019 10:58am

steddyeddy wrote: »

Let's take a look at just one of the drugs, Tecentriq, a treatment for breast cancer. This has a 19% objective response rate (the percentage of patients whose cancer shrinks or disappears) for triple negative breast cancer. This is a form of breast cancer where three receptors such as the oestrogen and progesterone receptor aren't expressed. Since these receptors are often the target of conventional therapies for breast cancer this type of breast cancer is incredibly difficult to treat. Now we have a drug that can extend your life by 19%. I can't see how you can deny this to people.

Might be the way it’s phrased, I’m neither a scientist nor a mathematician, but does that mean the drug is effective in only one in five people with those particular types of cancers, or does it actually mean that it increases the potential life span of all people with those particular types of cancer by one fifth?

Either way I’m reading that, it still appears to offer little value in proportion to it’s cost. I don’t think anyone wants to deny it to people, it’s just reality that the HSE cannot afford to offer the drugs at the same rate as a private health insurance company. I can actually see this becoming more and more of a thing as new drugs are developed which are going to become less affordable, but through social media and the media we will become aware of people who need them.

Bitches Be Trypsin · 15-04-2019 11:07am

steddyeddy wrote: »

Let's take a look at just one of the drugs, Tecentriq, a treatment for breast cancer. This has a 19% objective response rate (the percentage of patients whose cancer shrinks or disappears) for triple negative breast cancer. This is a form of breast cancer where three receptors such as the oestrogen and progesterone receptor aren't expressed. Since these receptors are often the target of conventional therapies for breast cancer this type of breast cancer is incredibly difficult to treat. Now we have a drug that can extend your life by 19%. I can't see how you can deny this to people.

I wouldn't suggest denying it to people at all. However, if public patients receive this drug, what perks do private patients then get? They deserve something if they are paying 1K a year on VHI or whatever provider they choose.

We need people to go private because the public service is strained as it is. To do this, we need incentives to go private that span beyond the usual shorter waits and private rooms (not even guaranteed!).

steddyeddy · 15-04-2019 11:09am

One eyed Jack wrote: »

Might be the way it’s phrased, I’m neither a scientist nor a mathematician, but does that mean the drug is effective in only one in five people with those particular types of cancers, or does it actually mean that it increases the potential life span of all people with those particular types of cancer by one fifth?

It means that 1 in 5 cancer patients with the worst form of breast cancer will see a reduction or disappearance of their cancer after taking the drug. It's also showing promising results for melanoma, lung and bladder cancers.

Either way I’m reading that, it still appears to offer little value in proportion to it’s cost.

20% of patients with the worst form of breast cancer have an increased chance of surviving and you don't think it's worth it?

I don’t think anyone wants to deny it to people, it’s just reality that the HSE cannot afford to offer the drugs at the same rate as a private health insurance company. I can actually see this becoming more and more of a thing as new drugs are developed which are going to become less affordable, but through social media and the media we will become aware of people who need them.

Well the HSE, an organisation that I briefly worked in is up there with RTE as a huge source of waste and entitlement. Not the doctors and nurses mind but the system itself. Our biochem lab ordered lab consumables at nearly 1.5 times the cost of the nearby university. This needs to be addressed.

One eyed Jack · 15-04-2019 11:31am

steddyeddy wrote: »

It means that 1 in 5 cancer patients with the worst form of breast cancer will see a reduction or disappearance of their cancer after taking the drug. It's also showing promising results for melanoma, lung and bladder cancers.

20% of patients with the worst form of breast cancer have an increased chance of surviving and you don't think it's worth it?

I think the hope is to convince the HSE to purchase the drugs at an earlier intervention stage in the same way as VHI are now doing, and even then the drugs are only effective for about one fifth of the people with those types of cancers. I don’t think it’s worth it tbh to be trying to be so bleeding edge about drugs which aren’t effective for 80% of people with those types of cancers, and they are still very expensive. The funding to pay for them has to come from somewhere, so that means the funding is most likely to come from the withdrawal of other treatments and services that were once provided by the HSE.

Well the HSE, an organisation that I briefly worked in is up there with RTE as a huge source of waste and entitlement. Not the doctors and nurses mind but the system itself. Our biochem lab ordered lab consumables at nearly 1.5 times the cost of the nearby university. This needs to be addressed.

Yeah I agree with you that there’s massive waste within the HSE, long identified as being top-heavy in admin, but the funding for new drugs isn’t going to come from admin salaries, it’s going to come from reducing the quality of treatments or withdrawal of treatments and services altogether from the majority, diverted to a small group of expensive but politically effective lobby cases that make the HSE and the Minister for Health look like they care about people.

steddyeddy · 15-04-2019 11:51am

Bitches Be Trypsin wrote: »

I wouldn't suggest denying it to people at all. However, if public patients receive this drug, what perks do private patients then get? They deserve something if they are paying 1K a year on VHI or whatever provider they choose.

Yes I think they should get faster access to elective surgery. Should they be dying of advanced breast cancer and feel the need to complain that a poorer patient is being offered the same chance of survival as them I'd recommend psychiatric treatment to them to be honest. It's not a normal mindset and not one that warrants further debate or dignity.

We need people to go private because the public service is strained as it is. To do this, we need incentives to go private that span beyond the usual shorter waits and private rooms (not even guaranteed!).

Pump more money into the public then. I think healthcare delivery should be the goal, not more people in private. Healthcare is massively subsidised anyway. There's no way it could be run simply for profit.

mariaalice · 15-04-2019 11:59am

steddyeddy you seem to be slightley obessed in thinking that we live in some sort of Elysium https://www.imdb.com/title/tt1535108/ where the cruel rich are walking all over the poor and laughing while they are doing it. Its a lot more complex than that.

Wealth will always bring privilege.

In this case, though the VHI just got there first the HSE will approve the drugs eventually they just seem to be a lot slower than the private sector.

Sugar Free · 15-04-2019 11:59am

I think these decisions on access are always emotive. The HSE presumably needs additional procurement budget for these medicines. So they either get it from somewhere within their own shop and cut elsewhere or they request more money from the government who in turn has to take from some other department or area of health. Neither of which will be popular. That's not to say it shouldn't be done, it's just unlikely that it can be achieved without making another group unhappy.

On the other hand, even if it's only for those with the right private insurance, it would be madness to deny people with life-threatening disease access to medicines that would increase their chances of survival. Although in any case as these drugs are all approved by the CHMP and HPRA, I don't believe there is any mechanism to prevent access to those who can or are willing to pay.

These types of decisions are going to become increasingly frequent as more and more CAR-T, checkpoint inhibitor and other immuno-oncology biologics gain approval. They're expensive to develop (I don't just mean the actual manufacturing/culturing process) and are often developed specifically for second or third line treatment in patients who are refractory to other standards of care or whose specific antigen/protein profile makes them otherwise unlikely to respond to first line therapy.

In other words it's going to cost payers more and more for a somewhat limited return and this will inevitably involve politics sooner or later. On the plus side, eventually these drugs come under pricing pressure from competitors, next generation molecules and biosimiliars so that they themselves become the more affordable standard of care. Unfortunately it won't help people who require this treatment now but that's the cycle of innovation with these medicines.

One eyed Jack · 15-04-2019 12:08pm

I think the point is eddy we could debate about saving people’s lives and dignity and all the rest of it till we’re blue in the face, but the question would still remain - where is all this extra public money supposed to come from that you want to pump into funding the purchase of wonderdrugs which are only suitable for a small number of small people with these conditions? In this case it’s cancers, last year it was cystic fibrosis and there are new drugs being approved in other markets all the time. We can calculate exactly when it isn’t viable to offer one treatment over another and it’s not that anyone intends to be heartless or cost people their lives. It’s simply the case that the HSE can’t afford it as it would mean denying healthcare to many more people in order to fund healthcare for a few. That’s not what public healthcare is supposed to be doing?

steddyeddy · 15-04-2019 1:29pm

mariaalice wrote: »

steddyeddy you seem to be slightley obessed in thinking that we live in some sort of Elysium https://www.imdb.com/title/tt1535108/ where the cruel rich are walking all over the poor and laughing while they are doing it. Its a lot more complex than that.

No offence M but you seem to use that strawman regularly. No one but no one is saying that. Literally no-one. You sound very young but there's more to debating healthcare, education ect to saying it's rich and poor.

The complexity of healthcare is lost on yourself and a others. Most people seem to think that in this case private health care customers pay more so should be entitled to greater access to treatment. I'll make this as clear as possible. I have experience in industry and academia in biotech. All healthcare is subsidised. No one pays the full amount for it. Some diseases such as cystic fibrosis aren't common enough to be worth researching were it not for massive government and some charity funding. The idea that an extra 1k a year for VHI should be the difference in life and death for someone with terminal breast cancer is ludicrous. It's not even a rich VS poor argument. 1000 a year isn't huge money.

One eyed Jack · 15-04-2019 1:41pm

It doesn’t sound complex at all though. This has nothing to do with public vs private healthcare, and everything to do with the fact that some people want public funds which are allocated to public healthcare to be spent on overly-expensive drugs which haven’t been shown to be cost effective, to treat a very small number of people. That sounds like a small number of people wanting to use the public healthcare system as their own private healthcare being supported by political and public lobbying rather than any examination of the cost of providing healthcare for that small group of people.

steddyeddy · 15-04-2019 1:45pm

One eyed Jack wrote: »

It doesn’t sound complex at all though. This has nothing to do with public vs private healthcare, and everything to do with the fact that some people want public funds which are allocated to public healthcare to be spent on overly-expensive drugs which haven’t been shown to be cost effective, to treat a very small number of people. That sounds like a small number of people wanting to use the public healthcare system as their own private healthcare being supported by political and public lobbying rather than any examination of the cost of providing healthcare for that small group of people.

Jack what formula are you applying to determine these drugs aren't cost effective?

Candamir · 15-04-2019 1:46pm

steddyeddy wrote: »

Let's take a look at just one of the drugs, Tecentriq, a treatment for breast cancer. This has a 19% objective response rate (the percentage of patients whose cancer shrinks or disappears) for triple negative breast cancer. This is a form of breast cancer where three receptors such as the oestrogen and progesterone receptor aren't expressed. Since these receptors are often the target of conventional therapies for breast cancer this type of breast cancer is incredibly difficult to treat. Now we have a drug that can extend your life by 19%. I can't see how you can deny this to people.

I’m not doubting your credentials and extensive experience in biotech, but you really have mangled that particular piece of data.

On a separate note, if people want the HSE to fund drugs and treatments that are not shown to be cost effective, I’d like them to nominate 20 (or whatever the equivalent cost) of their friends, neighbours and relatives who should do without their, say, hip replacement to fund that treatment.

There is no money tree.

ELM327 · 15-04-2019 1:51pm

If paying for private health insurance doesn't get you some advantages, what would be the point in having it?

steddyeddy · 15-04-2019 1:58pm

Candamir wrote: »

I’m not doubting your credentials and extensive experience in biotech, but you really have mangled that particular piece of data.

We'll agree to disagree C but what have I misrepresented and how would you present it?

One eyed Jack · 15-04-2019 1:59pm

steddyeddy wrote: »

Jack what formula are you applying to determine these drugs aren't cost effective?

I’m not applying any formula, I’m going on the statement released by the HSE in 2016 regarding these drugs and the cost of funding them vs the budget they have to run the Public Health Service -

HSE Statement Pembrolizumab and Nivolizumab

The HSE has a responsibility to source the most effective medicine on behalf of patients at an affordable price to the taxpayer. As is the case for all new medicines, the clinical benefits of pembrolizumab and nivolizumab are being carefully considered under a process of health technology assessment, in order to determine value for money and patient benefits.

Affordability of drugs generally, and of new medicines, is an issue globally and there are a range of other new medicines also becoming available to the market in 2016. The HSE must operate within its allocated budget for 2016 and within this prioritise the allocation of resources across the entire health system. In the 2016 HSE Service Plan an additional €7 million was allocated for Cancer Drugs to support the National Cancer Control Programme's Systemic Therapy Programme. In this context pembrolizumab, for example, has an estimated net 5 year cost implication to the state of €64m at the price being sought by the pharmaceutical company.

The HSE engages robustly with manufacturers to achieve the best price and the best value for Irish patients and the taxpayer. It is widely recognised that Ireland is already paying higher prices for medicines than many of our European neighbour states. The single biggest barrier to new drugs approvals in Ireland is the high prices that manufacturers are seeking to charge. Lower prices would enable the HSE to afford more innovative drugs for more patients as they become available and the HSE will continue to engage with manufacturers in the best interests of patients and the taxpayer.

howamidifferent · 15-04-2019 2:07pm

I pay €5200 per annum for VHI for my family from my net after tax income.
I've never had so much as a tooth pulled from all the PRSI I've payed in over the past 35 years. I think I'm quite entitled to expect 35 years of PRSI payments and 35 years of VHI payments plus all my taxes paid to give me at least some benefit over someone who does not pay private health insurance and in many cases may not even be paying PRSI. It's a choice I make to ensure I can avail of medical treatment if I require it, just as I fund my pension to ensure I have an income in retirement. Too many people expect the state (taxpayer) to fund them throughout life and into retirement. You make your choice when it comes to how you spend your money and if you dont deem healthcare a priority then dont whinge when your waiting with the other 2 million people who took the same stance as you did.

Kiith · 15-04-2019 2:09pm

Paying for private health care gives you a lot of benefits, but getting exclusive access to a potentially life saving drug should not be one of them.

As for the decision by the HSE to not allow these drugs for anyone on public, it seems like they had to balance the costs/benefits of these drugs, and they decided that they weren't worth it. They don't have an endless budget, and have to allocate money where they think it will do the most benefit. Unfortunately, these drugs do not fall under that right now.

Candamir · 15-04-2019 2:11pm

steddyeddy wrote: »

Let's take a look at just one of the drugs, Tecentriq, a treatment for breast cancer. This has a 19% objective response rate (the percentage of patients whose cancer shrinks or disappears) for triple negative breast cancer. This is a form of breast cancer where three receptors such as the oestrogen and progesterone receptor aren't expressed. Since these receptors are often the target of conventional therapies for breast cancer this type of breast cancer is incredibly difficult to treat. Now we have a drug that can extend your life by 19%. I can't see how you can deny this to people.

steddyeddy wrote: »

We'll agree to disagree C but what have I misrepresented and how would you present it?

Maybe they kept you away from the clinical side of things, but a 19% response rate in no way equates to ”a drug that can extend your life by 19%”. For a start.

markodaly · 15-04-2019 2:14pm

steddyeddy wrote: »

No offence M but you seem to use that strawman regularly. No one but no one is saying that. Literally no-one. You sound very young but there's more to debating healthcare, education ect to saying it's rich and poor.

The complexity of healthcare is lost on yourself and a others. Most people seem to think that in this case private health care customers pay more so should be entitled to greater pay. I'll make this as clear as possible. I have experience in industry and academia in biotech. All healthcare is subsidised. No one pays the full amount for it. Some diseases such as cystic fibrosis aren't common enough to be worth researching were it not for massive government and some charity funding. The idea that an extra 1k a year for VHI should be the difference in life and death for someone with terminal breast cancer is ludicrous. It's not even a rich VS poor argument. 1000 a year isn't huge money.

It seems you do a fair bit of straw-manning yourself.

Obvious Desperate Breakfasts · 15-04-2019 2:18pm

As a person without health insurance who has spent the last few years relying on these drugs to keep me alive, this makes me nervous. The next drug in the arsenal after my current one fails was only made available in Ireland in May 2018. I think it will now remain available to me as it’s already in the system but what if a decision had been made to just give it to those with health insurance? That option would be gone for me. And I can’t get health insurance now, I’m uninsurable. New drugs are becoming available all the time and some of them really do add on years. How agonising would it be to know there was a drug you couldn’t access?

ancapailldorcha wrote: »

The article is quite vague and, frankly of very poor quality. I don't read RTÉ so I suppose I am not missing much.

Nothing whatsoever is mentioned about these drugs save for that they are new. That's it. Are they drugs in the traditional sense, ie chemo? Or are they something else?

In the UK, we have the National Institute for Clinical Excellence (NICE) which must approve NHS funding for all drugs. It makes decisions based on drug efficacy, safety and value for money as health spending is finite. I don't know what the Irish equivalent is but the fact that the author of this piece never contacted them or mentioned this suggests that this is a clickbait article. We don't know if these new drugs perform any better than generics of if they just add a few months to a patient's life. If they don't perform well then the HSE has a tough call to make as this money can be spent elsewhere where it might reap more benefits.

A shame that RTÉ went for the clickbait article on such an important issue.

Sometimes it’s not brand name versions being kept from people where generics are given, sometimes the brand name version is the only version available.

steddyeddy · 15-04-2019 2:32pm

Candamir wrote: »

19% response rate in no way equates to ”a drug that can extend your life by 19%”.

Ah yea fair point. The rest of my paragraph stands though. I should have said "a drug which has a 19% chance of extending your life if you have triple negative breast cancer".

Anything else you disagree with?

steddyeddy · 15-04-2019 2:33pm

markodaly wrote: »

It seems you do a fair bit of straw-manning yourself.

Do these drugs not have the potential to save your life?

steddyeddy · 15-04-2019 2:35pm

ELM327 wrote: »

If paying for private health insurance doesn't get you some advantages, what would be the point in having it?

It's not up to the public to come up with reasons for why private health care should provide greater benefit.

Candamir · 15-04-2019 2:35pm

steddyeddy wrote: »

Ah yea fair point. The rest of my paragraph stands though. I should have said "a drug which has a 19% chance of extending your life if you have triple negative breast cancer".

Anything else you disagree with?

Well, it doesn’t necessarily mean that either, but I don’t have the full data set to say exactly what it does, or might mean.

markodaly · 15-04-2019 2:37pm

steddyeddy wrote: »

Do these drugs not have the potential to save your life?

Well, that is a subjective word, and if you do work in academia you would wise to follow the scientific principle, not some emotive clickbaity article.

ELM327 · 15-04-2019 2:41pm

steddyeddy wrote: »

It's not up to the public to come up with reasons for why private health care should provide greater benefit.

It's as if you have purposely misunderstood my post.

If I am paying for healthcare (which I am, approx 2500 per annum for couple), why would I bother if everyone is treated the same anyway??

jimmycrackcorm · 15-04-2019 2:53pm

This wouldn't be an issue if people paid the money on healthcare that they pay for alcohol and smokes every year.

Bear in mind also that private healthcare subsidises the public system by paying for facilities that the payees are entitled to anyway.

Obvious Desperate Breakfasts · 15-04-2019 2:56pm

Candamir wrote: »

Maybe they kept you away from the clinical side of things, but a 19% response rate in no way equates to ”a drug that can extend your life by 19%”. For a start.

The problem with statistics for cancer drugs is that cancer drugs work really well for some people and not at all for others. I was on a drug for over two years before it stopped working. My quality of life was really good for those two years. I had no side effects. For others, it won’t work at all. And some of the people it hadn’t worked for that I know of have the exact same subtype of cancer as me on paper. So, what will the stats say?

And I’d challenge anyone to look me in the eye and tell me that giving me a good two years with minimal side effects wasn’t worth whatever it cost the state. I’m in my 30s. In that two years, I got married, travelled to Iceland, saw the Northern Lights, enjoyed two more Christmases, two more birthdays, laughed, loved. The next drug I try might not work for me. Or I might get another two years. Maybe more. The drug that worked for two years for me sometimes works for way longer. Some people get five years out of it.

With cancer drugs, doctors don’t know if they will work for the individual in front of them. But they have to try because it will or it won’t and if it will, that patient could buy some serious time. If I was denied drugs due to not having health insurance, I probably would have been dead six months out from diagnosis. But I’m now approaching the fourth anniversary of my diagnosis.

And it’s not just an issue of patients being given generics rather than the brand name. If it’s a new drug, the brand name will be the only one that exists.

As for why I didn’t have health insurance. The arrogance of youth. Who expects to develop terminal cancer in their 20s? Especially a cancer with a median diagnosis age of about 60.

Private healthcare patients get exclusive access to cancer drugs

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