Guest speaker shares ideas on improving access

Metavivors NZ members were in full force at BCAC’s Annual General Meeting at Domain Lodge in Auckland recently. PHARMAC CEO, Steffan Crausaz also attended, as did Breast Cancer Support co-chairs Judith Shinegold and Lesley Harper, Michele Urlich from the Lymphoedema Support Network, and several other BCAC members.

BCAC Chairperson, Libby Burgess, described another full year of activity for BCAC. She thanked the 3,000 people who joined BCAC’s online campaign to let the Minister of Health know of the desperate need for better treatments for those with advanced breast cancer. 

While the call for better access to medicines is ongoing, Libby was pleased to note that BCAC’s request to extend the breast screening age band up to 74 years has succeeded, with the new government pledging to see this through.

Libby noted with deep sadness the passing of Moana Papa and Cheryle Moreton-Robins, two women who were inspirational, passionate and articulate in supporting others and seeking better outcomes for New Zealanders with breast cancer.

Building on the theme of access to medicines, guest Dr Chris Jackson, Medical Director of the Cancer Society of NZ, spoke on “Evidence, Access and Value: Do you get a say?” Dr Jackson outlined his thoughts on how the health system in New Zealand is both working for cancer patients and failing them.

He highlighted that New Zealand does some things well when compared with countries around the world. For example, New Zealand breast screening rates are good compared to other OECD countries, we have strong patient-led charities, and a number of other improvements have taken place recently including:

  • the funding of pertuzumab
  • a slow improvement in access to reconstruction
  • access to world class surgeons
  • a current zoledronic acid consultation
  • a promised extension of breast screening.

But Dr Jackson commented: “Simply because things are better than they were does not mean we should not strive to improve – 620 deaths are still too many.”

Dr Jackson noted that for every person that dies in a motor accident, New Zealand spends $2M on improving road safety, but for every cancer death, only $26,000 is invested in treatments to improve outcomes.

Focusing on a lack of access, particularly to new and advanced medicines, he acknowledged that PHARMAC, the government agency that decides which pharmaceuticals to publicly fund, has a difficult job. But he believes there are limitations to the PHARMAC model that need to be addressed.

These include:

  • The fixed budget
  • Drug-only reimbursement
  • Consultation only after preliminary decisions
  • No timelines for decisions or funding.

With a whole-of-system approach, Dr Jackson thinks we can improve on this model. The fixed budget means rather than “growing the pie”, it can only be cut and drug-only reimbursement creates barriers preventing some patients from accessing treatments.

For example, in the current PHARMAC zoledronic acid consultation, which proposes widening funded access to this drug to make it accessible to some women with early breast cancer, a further positive step would be to provide for a dental check-up and follow-up dental treatment if required.

These checks are needed given the risk in some patients of osteonecrosis of the jaw, a side-effect of this medicine. Without this extra support, some who qualify for publicly funded access to the cancer drug could not afford the necessary preliminary dental work.

This medicine should also be made available from GP clinics and funding provided for this, reducing the burden on hospital oncology clinics. This would also avoid inequities arising from differences in ability to take time away from work and family to travel to a distant clinic for treatment.

Providing funding beyond drug-only reimbursement could make a real difference because it would reduce inequities in the ability to access this treatment.

Other solutions to the limitations include: engaging earlier in the funding process with clinical experts, patient groups and pharmaceutical companies, creating goal posts, ensuring fixed time frames for decisions, establishing a comprehensive transparent medicines scorecard and having an appeals process.

Dr Jackson acknowledged the huge importance of the patient voice in persuading decision-makers to adopt a whole-of-system approach, and encouraged the audience to share their personal stories with their MPs.

The presentation generated many questions and discussion from the audience and Libby commented that it was encouraging to hear so many solution-based ideas.

“We are very grateful to Dr Jackson for giving us his time and expertise and we look forward to working with him and others in the health system to try and resolve some of the issues,” she said.

Chris Jackson is a Consultant Medical Oncologist with the Southern Blood and Cancer Service (Southern DHB) and Senior Lecturer in Medicine with the University of Otago. In 2015 he was appointed as Medical Director of the Cancer Society of NZ.

27 Nov 2017

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