New Zealanders deserve better access to medicines
Background document on better access to medicines
We represent New Zealanders with breast cancer but we speak for all New Zealanders in asking the Minister of Health to provide better access to medicines to save our lives and improve our health.
Cancer touches nearly every New Zealand family. One in three of us will eventually die of it. The number of cancer deaths increased by 12.8% between 2000 and 2010 and the impact of cancer on our population will continue to increase.[i]
Breast cancer in New Zealand
Every year around 3050 New Zealanders are diagnosed with breast cancer and 620 of us lose our lives to this disease.[ii] Our women are dying earlier than they should. Within 5 years of diagnosis, for every 7 Australian women who die, 10 New Zealand women will die, so we have a 40% higher death rate than Australia.[iii] Recent research has shown that if our 5-year survival rate was the same as Australia’s, 529 New Zealand women who died from breast cancer between 2006 and 2010 would still be alive.[iv] Across all cancers 3,631 New Zealanders would still be alive if they had been diagnosed and treated in Australia. A number of factors are thought to contribute to New Zealand’s higher death rate for breast cancer including later diagnosis, slower access to treatment and less effective therapy than in Australia. In New Zealand, Māori and Pacific women have significantly worse survival than other ethnicities, with the strongest reason for this being later diagnosis, when the cancer is at a more advanced stage.[v]
The New Zealand Government has recently established the laudable Faster Cancer Treatment programme to improve the speed of diagnosis and treatment. However, little has been done to improve access to effective new treatments. In particular, our access to innovative medicines is nothing short of dire, and while this continues New Zealanders will suffer worse outcomes.
New Zealanders’ access to new medicines
New Zealanders’ lack of access to new medicines is stark when we compare ourselves with other OECD countries. Between 2009 and 2014, across all diseases only 14 new medicines[vi] were publicly funded in New Zealand while 59 were funded in Australia and 131 in the UK.[vii] New Zealand had the lowest access to new medicines of all 20 OECD countries compared.
New Zealanders were given access to only 13% of the new medicines registered as safe and effective by New Zealand’s regulatory body Medsafe, compared to 39% in Australia and 80% in the UK. Access to these few drugs was also slow, with the average time between registration and funding being 579 days, compared to 383 days in Australia and 118 days in the UK.
There are currently five breakthrough breast cancer medicines funded in Australia to give longer, healthier lives to women with different types of breast cancer, but none of these is provided to New Zealand women.[viii]
The impact of New Zealand’s lack of access to new medicines
While effective new medicines remain unfunded, patients and their families are forced to pay high prices to gain access to these innovative drugs, or go without. This creates significant social inequity as some can afford to pay, some are forced to sell or mortgage their homes and others miss out entirely.
It is not only patients who will benefit from greater access to new cancer medicines. There are benefits to the health system in particular and society as a whole.
Innovative cancer therapies deliver on every measure. They:
- deliver longer, better lives for patients
- save our health system resources
- reduce hospital stays
- keep people working
- reduce palliative care
- keep families together.
They are economically as well as socially beneficial.[ix] New Zealand needs to catch up with the rest of the world.
New Zealand’s rigid pharmaceutical system
One of the reasons for our low and slow access to medicines is that, unlike other OECD countries, New Zealand’s medicines funding agency, PHARMAC, has a capped pharmaceutical budget. This means there is a fixed amount of money available for PHARMAC to invest in medicines, so for a new medicine to be funded, cost savings must be made elsewhere, often by removing funding for another medicine. This makes our funding system rigid and unresponsive when a breakthrough new treatment becomes available.[x]
Not only is New Zealand’s medicines budget capped, but it is also very small. For the 2016/17 year it is set at $850M, representing an investment of $180 per person.[xi] In contrast, in 2015 Australia spent $435 per person on medicines. [xii]
A further compounding issue is the high cost of innovative medicines. Pharmaceutical companies invest around USD $2.87 billion (2013 figure) to bring a single new medicine to market and are driven to retain economic viability and provide returns to shareholders.[xiii] Without successful pharmaceutical companies there would be no pipeline for new medicines. It is vital that these companies collaborate with government agencies to provide their successful new products at affordable prices.
Changes are needed to New Zealand’s pharmaceutical system
Following consultation, PHARMAC’s criteria for deciding which medicines to fund were revised in 2015 to include not only impacts on the pharmaceutical budget but also on people, whanau and communities, as well as the wider health system.[xiv] PHARMAC’s statutory obligation is to “…secure the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided”. The problem is clearly the amount of funding provided.
New Zealanders deserve a world-class health system that supports us to live long, healthy lives. Right now our women are dying needlessly of breast cancer, other cancer patients’ lives are shorter than they need to be and people with a range of diseases are suffering needlessly because they cannot access modern medicines available to the citizens of other developed countries.
We ask the Minister of Health to show leadership in developing long-term strategic solutions to give New Zealanders a fair deal, to future-proof NZ’s health system and to keep pace with innovation.
Minister, please invest more in the medicines that New Zealanders desperately need. Bring our pharmaceutical budget in line with the rest of the OECD. Remove the cap on the pharmaceuticals budget so that we can respond to need, save lives and provide the health benefits that innovative new medicines provide. Consider the strategies that other countries have adopted, such as Early Access to Medicines Schemes and Cancer Drugs Funds.
All New Zealanders deserve a healthcare system that gives us longer, healthier lives.
[i] Ministry of Health 2014. New Zealand Cancer Plan: Better, Faster Cancer Care 2015 – 2018.
[ii] Ministry of Health 2015. Cancer, New Registrations and Deaths 2012.
[iii] Campbell I.D., Scott N., Seneviratne S., Kollias, J., Walters D, Taylor, C, Webster F, Zorbas H and Roder DM 2014. Breast cancer survival in New Zealand women. ANZ J Surg. 2015 Jul; 85 (7-8):546-52. doi: 10.1111/ans.12851.
[iv] Sandiford, P., Abdel-Rahman, M. E., Allemani, C., Coleman, M. P., & Gala, G. (2015). How many cancer deaths could New Zealand avoid if five-year relative survival ratios were the same as in Australia? Aust N Z J Public Health, 39(2), 157-161. 10.1111/1753-6405.12344
[v] Seneviratne, S., Lawrenson, R., Scott, N., Kim, B., Shirley, R. and Campbell, I. 2015. Breast cancer biologu and ethnic disparities in breast cancer mortality in New Zealand: A cohort study. PLOS ONE. DOI: 10.1371/journal.pone.0123523
[vi] New medicines are defined as New Molecular Entities.
[vii] IMS Consulting Group 2015. Access to New Medicines: Comparison Across OECD Countries. Report for Medicines Australia. (Summarised version available in Medicines Australia 2015, Compare. www.medicines.com.au)
[viii] Breakthrough breast cancer medicines that improve and extend life and are funded in Australia but not New Zealand are Abraxane, Afinitor, Halaven, Perjeta and Kadcyla.
PBS 2016. Schedule of Pharmaceutical Benefits: Effective 1 September 2016. PBS, Department of Health, Australian Government. www.pbs.govt.au
PHARMAC 2016. New Zealand Pharmaceutical Schedule: effective 1st October 2016. Pharmaceutical Management Agency (PHARMAC). http://www.pharmac.govt.nz/Schedule
[ix] Lichtenberg F.R. and Williams-Spence, J.W. The impact of pharmaceutical innovation on the longevity and hospitalisation of New Zealand Cancer Patients 1998 – 2012.
[x] Wonder, M. and Milne, R. 2011. Access to new medicines in New Zealand compared to Australia. New Zealand Medical Journal Vol 124 No 1346, 12 – 28 ISSN 1175 8716 http://journal.nzma.org.nz/journal/124-1346/4966/
[xi] PHARMAC NZ; Pharmaceutical Benefits Scheme, Australia; Statistics NZ; Australian Bureau of Statistics.
[xiii] Di Masi, J.A. and Grabowski, H.G. and Hansen, R.W. 2016. Innovation in the pharmaceutical industry: new estimates of R&D costs. J. Health Econ. 47: 20-33. Doi:10.1016/j.jhealeco.2016.01.012
[xiv] PHARMAC 2015. Perscription for Pharmacoeconomic analysis. Methods for Cost-Utility Analysis. Version 2.2 – 2015.