By Rodger Tiedemann
5 Sep, 2023 05:00 AM
It is distressing to have to tell my cancer patients, in each and every clinic, that effective treatments exist that could significantly extend their lives, but that sadly these treatments are not available in New Zealand.
We are not speaking of the latest cutting-edge medicines. Far from it. Instead, even routine cancer treatments that have been funded for years in other countries, and that are considered to be the standard of care across the Western world, are often left unfunded in New Zealand and are thus denied to Kiwis with cancer.
Regrettably, “strangled” access to modern medicines has become a pervasive characteristic of New Zealand’s healthcare, and has created a disturbing gulf between Aotearoa and other Western nations in the delivery of cancer care. It affects thousands of Kiwis each year.
Perhaps you don’t believe it’s that bad? From 2011 – 2020, New Zealand funded only one-third of the new medicines that were funded by Australia (51 versus 143; Access to Medicines Report, 2021). Even worse, during the same period, New Zealand funded only 10 per cent of the new cancer medicines launched in the OECD. Unsurprisingly, Te Aho o Te Kahu – the Cancer Control Agency of New Zealand – has identified 20 gaps in national cancer care, where cancer medicines are publicly funded in Australia but not in New Zealand.
Even medicines eventually funded in New Zealand typically face years of delay. In 2013, Kiwi patients waited roughly as long as Australians for medicines reimbursement (402 vs. 398 days respectively). By 2020, the wait time in New Zealand had risen to 1014 days, compared to 422 in Australia. Incredibly, our wait times continue to grow, and New Zealanders in 2023 now wait 7.7 years on average (median 6.5) for a new medicine to become publicly funded.
In my specialty of multiple myeloma, three drugs – carfilzomib, pomalidomide and daratumumab – remain unfunded in New Zealand, despite being widely available in other Western countries. Consequently, Kiwis living with multiple myeloma in 2023 are not benefitting at all from the considerable global progress that has been made over the past decade in treating this cancer and are still being offered a level of care limited to that provided circa 2014 in Canada or the UK.
As an example, daratumumab is a monoclonal antibody that revolutionised the treatment of myeloma when it was introduced a decade ago. It received accelerated approval in the US in 2015. Two randomized studies demonstrated that it reduced the risk of myeloma disease or death by an impressive 60 per cent. It has since been funded in 49 countries. But not in New Zealand. For cancer patients, treatment delayed is treatment denied. Pharmac’s half-decade-long deliberation on daratumumab is indefensible. Patients die waiting for it. Indeed, Pharmac’s quiet foot-dragging approach to bringing new cancer medicines to our shores is difficult to reconcile with the way the Government values life. It is depriving Kiwis of years of lifespan, and it is denying our communities their contributions.
Can we afford modern cancer treatments? New Zealand is not a poor country. We rank 33rd in GDP per person (in US$) from 262 countries and economies. That places us between Germany and the UK, and ahead of France, Italy, Japan and Spain. However, whereas those countries respectively reimbursed 173, 164, 125, 119, 153 or 108 new medicines between 2015-2020, New Zealand reimbursed only 20 (Medicines Australia, 2022). So why doesn’t New Zealand fund modern medicines?
New Zealand’s total health expenditure per person per year – US$6061 ($10,202) – is not miserly, and falls between the UK and Germany, and behind France. As a percentage of GDP it even appears generous. In contrast, however, New Zealand’s spending on medicines – the Combined Pharmaceutical Budget – is incomprehensibly tight-fisted at only 0.38 per cent GDP. That is less than a third of the average OECD national expenditure on medicines of 1.41 per cent GDP. That stingy 28 per cent expenditure, compared to the average of comparable countries, directly explains the lower availability of publicly-funded medicines in New Zealand. This anomalous bottleneck in medicines spending is strangling medical care in our country. Modern care requires modern medicines.
Fortunately, the problem can be solved. Pharmaceutical spending accounts for only 4 per cent of the health budget; therefore significant improvements in medicines access can be achieved without outsized changes in total health expenditure. A fix is possible.
When Pharmac was created in 1993 it realised admirable savings by rationalising and negotiating pharmaceutical contracts at a national level. It was a source of pride. Due to underfunding, it has morphed, however, into an agency that now creates savings by denying and delaying the introduction of effective new medicines. That’s not something of which to be proud. Government funding and Pharmac’s culture need to change.
Rather than touting savings made by denying Kiwis modern care, the Government and Pharmac should be proud to bring newer and better treatments to New Zealanders. They should prize expediency. Kiwis deserve this and we can achieve it.
Rodger Tiedemann is an Associate Professor at the University of Auckland; Antony and Margaret Morris Fellow in cancer research; consultant haematologist at Auckland Hospital.