Private healthcare patients get exclusive access to cancer drugs

steddyeddy · 14-04-2019 9:04pm #1

Oncologists will now be only able to prescribe new potentially life saving cancer drugs to private patients. I think this is pretty scummy to be honest. Nobody pays the full cost of medical treatment/research and I think it's really a false ideology to say some people "earn" the right to more healthcare than a poorer person.

"Medical oncologist John Crown said he welcomes the move for VHI customers but is "personally very troubled by it".

He said: "For the first time since I can ever recall, we have a difference in access to cancer drugs between public and private patients. It's completely unfair. It's going to be extraordinarily difficult now."

https://www.rte.ie/news/health/2019/0414/1042590-cancer-drug/

whiskeyman · 14-04-2019 9:09pm

Your wealth is your health...

Ubbquittious · 14-04-2019 9:19pm

It must be terrible to be the recipient of inferior drugs knowing full well that they are inferior and that you're getting them for cost reasons.

If they took the nothing-doers out of the HSE there would be no need for this

Touchee · 14-04-2019 9:25pm

The way I read it is that these drugs were not available to anyone in the country. VHI is giving access to its customers, but the HSE has yet to add them to their cancer treatment list?

Maybe it's a case that the HSE must be pushed to also adopt these drugs, as soon as possible, to avoid discrimination between private and public patients.

ancapailldorcha · 14-04-2019 9:50pm

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.

Bitches Be Trypsin · 14-04-2019 9:53pm

Clickbait article.

I do believe though that having private health insurance should have some perks besides faster treatment and private rooms. Paying people should get superior treatment imo.

Kurtosis · 14-04-2019 10:01pm

The National Centre for Pharmacoeconomics evaluates the cost effectiveness of new medicines, and those that are cost effective are then reimbursed by the state. Based on the data submitted to them, these drugs weren't deemed cost effective for the conditions outlined in the article. This is why they aren't funded by the state for public patients. Covering these medicines would mean taking funding from other areas of the health system where it provides more benefit.

This is a dangerous precedent set by VHI, it's effectively subverting the national process for economic evaluation of medicines. It's effectively going to be a means for pharmaceutical companies to gain extra leverage in getting new medicines reimbursed at higher prices.

steddyeddy · 14-04-2019 10:05pm

Irish Times article on the same issue. The Irish Cancer Society and John Crown, Ireland's top oncologist have weighed in on this being unfair.

https://www.google.com/amp/s/www.irishtimes.com/news/health/access-to-cancer-drugs-for-private-patients-incredibly-unfair-1.3860348%3fmode=amp

Kurtosis · 14-04-2019 10:06pm

Bitches Be Trypsin wrote: »

Clickbait article.

I do believe though that having private health insurance should have some perks besides faster treatment and private rooms. Paying people should get superior treatment imo.

We already have a system where time to access treatment is based on ability to pay rather than medical need, which is scandalous enough. And you genuinely want there to be extra advantages for the wealthy? I'm glad most of our political parties disagree and have a strategy to move away from this two tier system.

paddy19 · 14-04-2019 10:12pm

The real question, as highlighted by professor Crown, is what the hell VHI are at.

The VHI have no expertise in evaluating cancer drugs.

The drug companies use vulnerable cancer patients to try to blackmail higher prices from the taxpayer.

They are helped by the media who think we should base drug approval based on patients experience rather than scientific data.

Dravokivich · 14-04-2019 10:34pm

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.

Damn near all news media has descended to click bait now.

Wibbs · 14-04-2019 10:38pm

Kurtosis wrote: »

We already have a system where time to access treatment is based on ability to pay rather than medical need, which is scandalous enough. And you genuinely want there to be extra advantages for the wealthy? I'm glad most of our political parties disagree and have a strategy to move away from this two tier system.

HOpefully that remains the case K, unfortunately the "money", that is the insurance industry and those who benefit from it would only love to have everywhere set up like the US medical service, based on insurance and wealth. And they'll push hard for it. Look at pet insurance over the last twenty years since it snuck in. Vet bills have gone way up within the insurance framework and if you go off the books it goes pretty crazy to keep you on the books and compliant. Oh and vets aren't seeing much benefit back from it contrary to popular belief. The insurance industry hates public health and will lobby hard against it.

MIKEKC · 14-04-2019 10:40pm

Kurtosis wrote: »

We already have a system where time to access treatment is based on ability to pay rather than medical need, which is scandalous enough. And you genuinely want there to be extra advantages for the wealthy? I'm glad most of our political parties disagree and have a strategy to move away from this two tier system.

Just because you have private health insurance doesn't mean you are wealthy. For many it's a choice, some feel they shouldn't need it after paying PRSI . Others chose to spend their money in different ways

14-04-2019 10:42pm

what do we know about the drugs? the IT suggests they may not work
https://www.irishtimes.com/news/health/access-to-cancer-drugs-for-private-patients-incredibly-unfair-1.3860348
i wonder if this is a price gouging exercise for vhi rather than an actual useful drug not being funded by the hse. if it is the latter, they should be told to get on it asap

14-04-2019 10:44pm

paddy19 wrote: »

The real question, as highlighted by professor Crown, is what the hell VHI are at.

The VHI have no expertise in evaluating cancer drugs.

The drug companies use vulnerable cancer patients to try to blackmail higher prices from the taxpayer.

They are helped by the media who think we should base drug approval based on patients experience rather than scientific data.

This poster gets what's going on precisely. Trace this story back and you'll find it's from one of the associated pharma companies attempting to use the media to put pressure on the Irish state to pay a higher price for their "essential" drug. The day journalists in our "free press" stop being self-serving, sycophantic bag boys for the agendas of the powerful will never happen.

One eyed Jack · 14-04-2019 10:48pm

Kurtosis wrote: »

We already have a system where time to access treatment is based on ability to pay rather than medical need, which is scandalous enough. And you genuinely want there to be extra advantages for the wealthy? I'm glad most of our political parties disagree and have a strategy to move away from this two tier system.

I didn’t read anywhere in the post you quoted where the poster suggested there should be extra advantages for the wealthy? There should be extra advantages for people who are willing to pay privately for their own healthcare, a system which our political parties are trying to make everyone move towards by putting additional levies on people who only choose to take out private health insurance in later life, in an attempt to make people take out private health insurance when they’re younger.

One of the benefits private health insurance providers are able to offer to their customers is earlier access to innovative treatments. It’s not unfair when the person is paying for it, that’s how insurance works!

Whether or not the Minister for Health decides to approve the early intervention treatments for public patients is entirely up to him, but simply suggesting it’s “unfair” that the treatments aren’t available on the public dime when it’s not cost-effective to do so, that’s not unfair when it’s exactly what people who choose to pay for private health insurance are paying for!

Kurtosis · 14-04-2019 11:05pm

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.

One eyed Jack · 14-04-2019 11:30pm

Kurtosis wrote: »

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.

I get what you’re saying, but the provision of medicine can’t just be based upon medical need, as it has to be paid for. That’s why we have bodies like NCPE and why the Orkambi fiasco was just that - the HSE simply can’t afford it, and it was an entirely politically motivated decision to pay for it.

You keep saying that it’s unfair that when someone pays for better medical treatment that they have access to better medical treatment. In my view it would be unfair if people who weren’t willing to pay for private health care were able to access the same level of healthcare as those who have chosen to pay for it with insurance premiums.

How does it sound fair to you that someone who has never paid for private health insurance would receive the same standard of healthcare as someone who has always paid their insurance premiums just in case they ever needed to avail of private healthcare?

It’s not really jumping the queue, it’s paying for a better healthcare service than is offered by the public health system. I know that these practices are putting the Minister for Health over a barrel in a time when there are many people who expect all sorts without having to pay for it, but simply calling it “unfair” should never have the Minister reverse the decision not to pay over the odds for medical treatments when it isn’t economically viable to pay for them from the public purse, because that’s unfair - now not only am I paying more for some politicians idea of socialised medicine, I’m also still paying for private health insurance too. That’s unfair.

Pretty Polky · 14-04-2019 11:31pm

Money talks in this country. Simple as that.

14-04-2019 11:37pm

Why the hell would you pay for private healthcare if there was zero advantage to it?

I'd be quite happy to stop paying for healthcare if the public system was better as it's not cheap.

14-04-2019 11:38pm

Pretty Polky wrote: »

Money talks in this country. Simple as that.

In every country.

steddyeddy · 15-04-2019 12:08am

bluewolf wrote: »

what do we know about the drugs? the IT suggests they may not work
https://www.irishtimes.com/news/health/access-to-cancer-drugs-for-private-patients-incredibly-unfair-1.3860348
i wonder if this is a price gouging exercise for vhi rather than an actual useful drug not being funded by the hse. if it is the latter, they should be told to get on it asap

It says they may not work for some people and work great for others. This is like a lot of drugs. Depending on your genotype you'll metabolize drugs differently. Some people do well on anti-depressents while some don't for example. Also these drugs are for late stage cancers where you really need to try anything you can. It would be the difference between life and death.

15-04-2019 8:15am

Bitches Be Trypsin wrote: »

Clickbait article.

I do believe though that having private health insurance should have some perks besides faster treatment and private rooms. Paying people should get superior treatment imo.

I'd have no problem with that, if private healthcare weren't already subsidised through the HSE and tax rebates for health insurance.

If you want better treatment pay for it all yourself.

As far as I'm concerned, the current model of health insurance should only be for increased comfort and perhaps slightly faster access to elective procedures.

WeIrishareEvil · 15-04-2019 9:05am

steddyeddy wrote: »

Oncologists will now be only able to prescribe new potentially life saving cancer drugs to private patients. I think this is pretty scummy to be honest. Nobody pays the full cost of medical treatment/research and I think it's really a false ideology to say some people "earn" the right to more healthcare than a poorer person.

"Medical oncologist John Crown said he welcomes the move for VHI customers but is "personally very troubled by it".

He said: "For the first time since I can ever recall, we have a difference in access to cancer drugs between public and private patients. It's completely unfair. It's going to be extraordinarily difficult now."

RTE doing a Daily Express here. Article says nothing. Nothing at all.

BattleCorp · 15-04-2019 9:42am

paddy19 wrote: »

The real question, as highlighted by professor Crown, is what the hell VHI are at.

The VHI have no expertise in evaluating cancer drugs.

The drug companies use vulnerable cancer patients to try to blackmail higher prices from the taxpayer.

They are helped by the media who think we should base drug approval based on patients experience rather than scientific data.

You do realise that these are proper drugs and have been tested and cleared for use. You are making it sound like the drugs haven't been evaluated. They have been cleared for use by the HPRA (Medicines Board).

The VHI are an insurance company. They should have nothing to do with evaluating cancer drugs as they are unqualified to do that.

Your gripe should be with the Government because the VHI are willing to pay for these drugs but the Government are not (yet).

I will agree with you that these drugs are very very expensive but developing and testing drugs is a ridiculously expensive thing to do.

mariaalice · 15-04-2019 9:45am

Its slightly click bait, the HSE does offer the drugs in some cases, however, the VHI is giving the consultant the option of prescribing it for any case they see fit.

Hobosan · 15-04-2019 9:55am

I use €500 notes as plasters. Not even the best health insurance on the market can offer that service.

ashes2014 · 15-04-2019 9:57am

I am afraid that this practice will become more and more common.

The public healthcare system will get worse and worse and we will all have to pay for private healthcare out of fear.

steddyeddy · 15-04-2019 10:23am

WeIrishareEvil wrote: »

RTE doing a Daily Express here. Article says nothing. Nothing at all.

I linked two articles in this. The "nothing at all" people are proclaiming is based on an inability to look up further information or understand the facts involved.

steddyeddy · 15-04-2019 10:26am

The British newspaper the Times are also weighing in on it.

The former director-general of the HSE has described a two-tier drugs treatment system for cancer patients as “terrible” and said it will have a far-reaching impact.

Last week oncologists learnt that certain cancer drugs known to help people with breast cancer and melanoma would be made available to patients with health insurance from VHI Healthcare. In a letter the insurer said it would provide its patients with access to the breast cancer drug Pertuzumab (perjeta) and immunotherapies such as Tecentriq (atezolizumab), Keytruda (pembrolizumab) and Opdivo (nivolumab).

mariaalice · 15-04-2019 10:32am

Interesting point, why can't the HSE procedure the drug through the VHI as the VHI has cut a deal with the drug company.

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.

Private healthcare patients get exclusive access to cancer drugs

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