5 months Ago
Patients with advanced ovarian cancer who lack the BRCA mutation and those with metastatic breast cancer will no longer gain access to the drugs through the basic package. This is the first time high-cost drugs are being partially delisted upon review. The shift is part of a larger initiative under the Integrated Care Agreement, brokered by hospital providers and payers, to rein in skyrocketing cancer treatment costs.
Cost Pressures and Conditions for Reassessment
In 2012 the cost of medicines in the Netherlands accounted for >€1.1 billion, and 27% involved cancer medications. By 2021, that amount had grown to €2.6 billion, and 59% was spent on treatments for cancer patients, even though those treatments alone have not led to major increases in the length of patients' lives. The compromise now calls for a review of whether treatments actually provide a life-extending or curative benefit and whether their effects differ by type of patient, such as those with genetic mutations.
Around 1,000 patients in the Netherlands use PARP inhibitors each year, at a cost of more than €30 million. With the new decision, usage is expected to be cut by around half, which would release tens of millions of euros for other types of care.
Disagreement on the Quality of Research and Decision Making
A Reyners, chairwoman of the Dutch Society for Medical Oncology, said she supported treatment re-evaluations, but criticized the laborious current system and said it included questionable research used by the drug-funding agency. And in some cases, she said, the patient groups were too hazy to prove or disprove the drugs' effectiveness. This might lead to some patients losing access to treatment unfairly.
Lonneke Koenraadt-Janssen of the Healthcare Institute said a lack of easily accessible Dutch patient data hindered the re-evaluation. Nevertheless, the Institute found, that there was no proof that any of the medications enhanced quality of life or prolonged survival in all but the sickest of the groups.
Cancer patient advocacy groups also criticized the emphasis on the median over the experience of individual patients. Koenraadt-Janssen replied that survival and quality of life were in fact looked at, but no improvement with the drugs over placebo or chemotherapy had been demonstrated.
She recognized that the decision was tough, but emphasized with soaring health care costs such reassessments must be made. The fact-finder also accepted the value of clear and consistent assessments in future, to help promote transparency and fairness.
