Abstract
Cancer is a major burden on populations and health systems internationally. The development of innovative cancer medicines is seen as a significant part of the solution. These new cancer medicines are, however, expensive, leading to limited or delayed access and disagreements among stakeholders about which medicines to fund. There is no obvious resolution to these disagreements, with stakeholders holding firmly to divergent positions. Access to cancer medicines was recently explored in Australia in a Senate Inquiry into the Availability of New, Innovative, and Specialist Cancer Drugs in Australia. We analysed the resultant Senate Report to identify competing stakeholder values. Our analysis illustrates that there are four main “goods” prioritized by different stakeholders: 1) innovation, 2) compassion, 3) equity, and 4) sustainability. We observe that, with the exception of sustainability, all of these “goods” put pressure on payers to provide access to cancer medicines more quickly and based on less rigorous evaluation processes. We then explore the consequences of giving in to such pressure and suggest that deconstructing the implicit values in calls for “enhanced access” to cancer medicines is necessary so that more nuanced solutions to the challenge of providing access to these high cost medicines can be found.
Similar content being viewed by others
References
Booth, C.M., G. Dranitsaris, M.C. Gainford, et al. 2007. External influences and priority-setting for anti-cancer agents: A case study of media coverage in adjuvant trastuzumab for breast cancer. BMC Cancer 7(1): 110.
Conti, R.M., and M.B. Rosenthal. 2016. Pharmaceutical policy reform—Balancing affordability with incentives for innovation. New England Journal of Medicine 374(8): 703–706.
Daniel, H. 2016. Stemming the escalating cost of prescription drugs: A position paper of the American College of Physicians. Annals of Internal Medicine 165: 50–52.
Deloitte Access Economics. 2013. Access to cancer medicines in Australia. http://medicinesaustralia.com.au/files/2013/07/Access-to-oncology-medicines-1707-FINALV3.pdf. Accessed September 21, 2016.
Doglin, E. 2010. Big pharma moves from “blockbusters” to “niche busters.” Nature Medicine 16: 837.
Dunlevy, S. 2015. The life saving black magic pill that costs $140,000 a year. The Advertiser, September 5.
European Commission Health Research Directorate. 2010. Workshop report: Personalised medicine: Opportunities and challenges for European healthcare. https://ec.europa.eu/research/health/pdf/13th-european-health-forum-workshop-report_en.pdf. Accessed April 28.
Experts in Chronic Myeloid Leukemia. 2013. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: From the perspective of a large group of CML experts. Blood 121(22): 4439–4442.
Fojo, T., and C. Grady. 2009. How much is life worth: Cetuximab, non-small cell lung cancer, and the $440 billion question. Journal of the National Cancer Institute 101(15): 1044–1048.
Fojo, T., S. Mailankody, and A. Lo. 2014. Unintended consequences of expensive cancer therapeutics-the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity. JAMA Otolaryngology—Head & Neck Surgery 140(12): 1225–1236.
Ghinea, N., W. Lipworth, and I. Kerridge. 2016. Propoganda or cost of innovation? Challenging the high price for new drugs. The British Medical Journal 352: i1284.
Gibson, S., H.R. Raziee, and T. Lemmens. 2015. Why the shift? Taking a closer look at the growing interest in niche markets and personalized medicines. World Medical & Health Policy 7(1): 3–27.
Goldstein, D.A., J. Clark, Y. Tu, et al. 2016. Global differences in cancer drug prices: A comparative analysis. ASCO Annual Meeting. http://meetinglibrary.asco.org/content/164423-176. Accessed August 9, 2016.
IMS Institute. 2014. Impact of cost-per-QALY reimbursement criteria on access to cancer drugs. http://www.imshealth.com:90/files/web/IMSH%20Institute/Healthcare%20Briefs/IHII_CPQ_Impact_on_Access_to_Cancer_Drugs.pdf. Accessed August 9, 2016.
Hill, A., D. Gotham, J. Fortunak, et al. 2016. Target prices for mass production of tyrosine kinase inhibitors for global cancer treatment. BMJ Open 6(1): e009586.
Howard, D.H., P.B. Bach, E.R. Berndt, and R.M. Conti. 2015. Pricing in the market for anticancer drugs. Journal of Economic Perspectives 29(1): 139–162.
Kantarijian, H.M., T. Fojo, M. Mathisen, and L.A. Zwelling. 2013. Cancer drugs in the United States: Justum pretium—the just price. Journal of Clinical Oncology 31(28): 3600–3604.
Kim, C., and V. Prasad. 2015. Cancer drugs approved on the basis of a surrogate end point and subsequent overall survival: An analysis of 5 years of US Food and Drug Administration Approvals. JAMA Internal Medicine 175(12): 1992–1994.
Lewis, R.R., I. Kerridge, and W. Lipworth. 2015. Coverage with evidence development and managed entry in funding of personalized medicine: Practical and ethical challenges for oncology. Journal of Clinical Oncology 33(34): 4112–4117.
Lichtenberg, F.R. 2015. The impact of pharmaceutical innovation on premature mortality, hospital separations, and cancer survival in Australia. https://medicinesaustralia.com.au/wp-content/uploads/sites/52/2010/01/20151124-Lichtenberg-paper.pdf. Accessed May 1, 2016.
Mackenzie, R., S. Chapman, G. Salkeld, and S. Holding. 2008. Media influence on Herceptin subsidization in Australia: Application of the rule of rescue? Journal of the Royal Society of Medicine 101(6): 305–312.
McCormack, K.C. 2014. Ethos, pathos, and logos: The benefits of Aristotelian rhetoric in the courtroom. Washington University Jurisprudence Review 7(1): 131–155.
Mooney, G. 2000a. Judging goodness must come before judging quality—But what is the good of health care? International Journal for Quality in Health Care 12(5): 389–394.
––––––––. 2000b. Vertical equity in health care resource allocation. Health Care Analysis 8: 203–215.
Morgan, D. 2015. Obama administration seeks to negotiate Medicare drug prices. Reuters, February 2.
Mulcahy, N. 2016. Study: Cancer patient advocates like pharma money: Quiet about high price of drugs. Medscape, November 16.
Olver, I. 2015. Explainer: How does Keytruda treat melanoma and why is it so costly? The Conversation, April 23.
Pace, J., N. Ghinea, I. Kerridge, and W. Lipworth. 2017. Accelerated access to medicines: An ethical analysis. Therapeutic Innovation & Regulatory Science 51(2): 157–163.
PhRMA. 2014. Nearly 800 new medicines in development to help in the fight against cancer. October 6, 2014. http://www.phrma.org/media-releases/nearly-800-new-medicines-in-development-to-help-in-the-fight-against-cancer/. Accessed April 27, 2016.
Rappeport, A., and S. Kirchgaessner. 2011. Industry criticises Obama’s call for cheaper drugs. Financial Times, April 14.
Schoonveld, E. 2016. ACP’s drug cost paper ignores economic reality. PharmExec.com, April 11.
Senate Community Affairs Reference Committee. 2015. Availability of new, innovative and specialist cancer drugs in Australia. September 17.
Silverman, E. 2015. Angry over drug prices, more states push bills for pharma to disclose costs. The Wall Street Journal, April 24.
Skerritt, J. 2015. Impact of innovative therapies on the regulation of therapeutic goods. Presentation at ARCS annual general meeting, November 26, in Melbourne, Australia.
Tefferi, A., H. Kantarjian, S.V. Rajkumar, et al. 2015. In support of a patient-driven initiative and petition to lower the high price of cancer drugs. Mayo Clinic Proceedings 90(8): 996–1000.
Towers, M. 2015. Big pharma’s had a gutful of PBS: Report. The Australian, September 23.
Trusheim, M.R., E.R. Berndt, and F.L. Douglas. 2007. Stratified medicine: Strategic and economic implications of combining drugs and clinical biomarkers. Nature Reviews Drug Discovery 6(4): 287–293.
World Health Organization. 2016. Cancer. http://www.who.int/cancer/en/. Accessed April 27, 2016.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ghinea, N., Little, M. & Lipworth, W. Access to High Cost Cancer Medicines Through the Lens of an Australian Senate Inquiry—Defining the “Goods” at Stake. Bioethical Inquiry 14, 401–410 (2017). https://doi.org/10.1007/s11673-017-9800-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11673-017-9800-2