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15-04-2019, 10:32   #31
mariaalice
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Interesting point, why can't the HSE procedure the drug through the VHI as the VHI has cut a deal with the drug company.
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15-04-2019, 10:38   #32
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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.
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15-04-2019, 10:46   #33
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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.
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15-04-2019, 10:58   #34
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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.
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15-04-2019, 11:07   #35
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Originally Posted by steddyeddy View Post
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!).
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15-04-2019, 11:09   #36
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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.

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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?

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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.
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15-04-2019, 11:31   #37
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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.


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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.
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15-04-2019, 11:51   #38
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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.

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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.
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15-04-2019, 11:59   #39
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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.
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15-04-2019, 11:59   #40
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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.
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15-04-2019, 12:08   #41
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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?
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15-04-2019, 13:29   #42
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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.

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15-04-2019, 13:41   #43
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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.
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15-04-2019, 13:45   #44
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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?
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15-04-2019, 13:46   #45
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Originally Posted by steddyeddy View Post
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.
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