‘Low and slow' uptake of new cancer drugs impacting on patient survival rates

Patients around the world face stark inequalities in access to cancer treatment, according to a report published on May 10, 2007, in the cancer journal, Annals of Oncology*. In South Africa, as well as New Zealand, Poland, Czech Republic and the UK, the uptake of new drugs is “low and slow” when compared to countries such as Austria, France, and the US, which are seen as leaders in the uptake of new cancer drugs.

The report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival.

The report by Dr Nils Wilkings, Clinical Oncologist at the Karolinska Institute in Stockholm, Sweden and Dr Bengt Jönsson, Director of the Centre of Health Economics at the Stockholm School of Economics, updates and improves on an earlier report by the same authors published in 2005.

The new report covers 25 countries, including South Africa, Australia, Canada, New Zealand, Japan, and the USA, as well as 19 European countries, with a total population of 984 million, and it looks at access to 67 innovative cancer drugs.

According to the report, Austria, France, Switzerland and the US are the leaders in the use of new cancer drugs with France replacing Spain among the top four since the 2005 report was published.

Progress in treatments brings benefits

“The greatest differences in uptake were noted for the new colorectal and lung cancer drugs (these are among the world's top cancers killers for both men and women). The USA's uptake of treatment for colorectal cancer was ten times more than the uptake in Europe,” says Dr Jönsson.

Dr Wilking says, “Progress in medical treatments has meant that over half of the patients diagnosed with cancer will now be “cured” or die from other causes. These benefits however, are only realised once the drugs get to the patients. Where you live can determine whether you receive the best available treatment or not. To some extent this is determined by economic factors, but much of the variation between countries remained unexplained.

In the US we have found that the survival of cancer patients is significantly related to the introduction of new oncology drugs. From a European perspective, we have found differences in access reflected patient outcome in the five major western European countries; France, Germany, Italy, Spain and the UK. Of these five European countries, France has the highest five-year survival rate for all cancers (71% for women and 53% for men). Spain had five-year survival rates of 64% and 50% respectively, in Germany it was 63% and 53%, in Italy 63% and 48% and the UK had the lowest at 53% and 43% respectively.

The South African scenario

The report shows that in South Africa, newer drugs such as trastuzumab (Herceptin) for breast cancer, where use is limited to people with medical aid, the uptake is similar to the uptake in former communist countries such as the Czech Republic, Poland and Hungary. It is far lower than the uptake in Germany France and the UK.

According to the report, during the period 1995 to 2005, 28 new cancer drugs were approved by regulators and introduced into the global market. Of these drugs, only 15 were approved locally for registration.

The authors called for action to end all inequalities. “It is our hope that this report will inspire policy makers and decision makers to take action to address these imbalances so that access to new innovative cancer drugs does not become dependent on the patient's country of residence,” they say.

The report shows that cancer is a significant burden to society. The most commonly used measure of the burden of cancer is the Disability Adjusted Life Year (DALY). This is an integrated measure of mortality and disability developed by the World Health Organisation (WHO) and the World Bank. One DALY can be thought of as one lost year of “healthy” life. The report shows that in South Africa, approximately 450 000 years of “healthy” life are lost to cancer per annum. In Australia and New Zealand, the figure is 350 000.

A need to reduce the review time for new cancer drugs

Dr Jönsson says, “Cancer accounts for about 5-6% of all healthcare expenditure and cancer drugs account for between 10-20% of this expenditure and just 5% of all drug costs. However, cancer research continues to grow, with many drugs and treatments expected to be introduced in the coming years. Countries need to address urgently how they are going to accommodate newer drugs in healthcare systems and pay for them.”

Economic evaluation of new drugs and their cost effectiveness are becoming increasingly important, the authors say, with Europe and the UK in particular playing a leading role in the production of health technology assessments.

The authors make a series of recommendations for ensuring that patients can have equal and rapid access to new cancer drugs. They include:

Reducing the review time for the marketing authorisation of new cancer drugs;
1. Ensuring that once authorisation is obtained, the drug is available at national level without further delays due to price and reimbursements negotiations;
2. Ensuring that any economic evaluation or health technology assessment is done quickly to facilitate, and not delay patient access; and
3. Ensuring that appropriate and adequate funding for new innovative cancer drugs is available in the healthcare system and hospital budgets, preferably on a proactive basis and not reactive basis i.e. by planning ahead.

Dr Jönsson concludes that, “We believe that the inequalities between countries in patients' access to cancer drugs cannot persist. Cancer patients will not accept that a standard of care available in one country is not available in other countries. Research on patient access to new treatment is a new and important part of translational cancer research.”

*A global comparison regarding patient access to cancer drugs. Annals of Oncology. Doi:10.1093/annonc/mdm095-103 [2] The report was funded by an unrestricted grant from F Hoffman La-Roche Ltd. Hence the findings and conclusions of the report are independent and solely of the authors.

Report courtesy of Annals of Oncology