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Two-tier drug access a 'real issue' for equity says head of HSE's drug-review centre

VHI recently offered its members access to new cancer drugs not currently available to all HSE patients.

Image: Shutterstock/Africa Studio

THE HEAD OF the National Centre for Pharmaco-economics said the decision by VHI to offer cancer drugs – not available to public patients – raises a “real issue” of equity within the Irish healthcare system. 

The NCPE is responsible for assessing the cost-effectiveness of pharmaceutical products  before a decision is made by HSE executives to either bring them on stream for public patients or refuse them. 

Yesterday, the Sunday Business Post revealed that new cancer drugs would be made available to VHI members who are being treated for melanoma, breast and lung cancers, despite the HSE only offering those drugs to patients with severe stage four cancers. 

Speaking to Sean O’Rourke on RTÉ Radio 1 today, Professor Michael Barry, clinical director with the NCPE, said the current system for reviewing and approving new drugs was effective, but that there are often delays at the funding stage.

“The main problem that it raises, of course, is the issue of equity and a differential here where public patients may not be able to access therapies and private patients can, and that is a real issue,” he said. 

“I keep reminding people that we actually don’t have an assessment problem, we have a funding problem – and so the assessments of these drugs will be completed by-and-large in under six months which is pretty good.

“The availability of the drug may take much longer and that’s down to funding and down to budget impact on these drugs.”

When drugs are reviewed and approved for use, the HSE enters into negotiations with the pharmaceutical companies to ensure “value for money,” according to Barry. 

The leverage the HSE now has to negotiate its own price for these drugs may now have been negatively impacted by VHI’s decision to agree a price and make the drugs available to its own members, he said.

Cost analysis

Meanwhile, the cost analysis carried out by the NCPE for just one of the drugs – Pertuzumab – used to treat breast cancer, would require a budget of €100 million over the next five years. 

“We finished our assessments of [Pertuzumab] in January of this year, we concluded that, yes there was value in the drug, but we felt that the price was to high at about €61,000 per patient, per year.

“So we suggested to the HSE that negotiations would be required and they’re ongoing at this point in time.

“The system that we have in place at the moment, for all of whatever people may feel about it, the one thing it does is it ensures equity,” Barry said. 

“These are very expensive drugs and if we were to replicate the VHI decision today [...] it would cost over €100 million over the next five years – that shows you what the implications are of such decisions.

Other drugs now reported to be offered to VHI members include Tecentriq (Atezolizumab) Keytruda (Pembrolizumab) and Opdivo (Nivolumab).

Frustrating 

Dr Janice Walsh, consultant oncologist at St Vincent’s and Tallaght also told Sean O’Rourke, the two-tier access to drugs was “frustrating” for medical practitioners who cannot provide the same therapies to public patients as they can to private patients.

“There is a process involved for the approval of these drugs, however, the very frustrating bit for us is that very often it will go through that process, be approved in theory and then will go up to HSE leadership,” Walshe said.

“Then the budget has to be approved by the HSE and there is no transparency in that regard, so it’s very difficult.

“Very often, we’re waiting for a very long time to find out if these drugs are going to be approved or reimbursed.”

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