Innovation in oncology: the impact of new drugs on patients and NHS

Blog article
Cinzia ARU

Blog imageThe 11th National Day of cancer patients, organized by FAVO (Italian Federation of Voluntary Associations in Oncology), held in Rome from 12 to 15 May, was the ideal opportunity to reflect on the impact that innovative drugs are having both in the lives of cancer patients and in the management of the resources of our NHS.

Cancer patients in Italy: according to reports from the8th Report on the Welfare Condition of Cancer Patients, presented on Thursday, May 12, 2016 in the Library of the Senate of the Republic, in 2015 366,000 new cases of cancer and 175,000 deaths were diagnosed, while cancer patients in treatment were about 3 million (airtum data, see figure). Although there is substantially an increase in the incidence of all forms of cancer, we are simultaneously seeing an increase in the years of survival after diagnosis: 27% of patients (20% of men and 33% of women) can be called "already cured", while 60% of those diagnosed with cancer have been diagnosed for over 5 years. Survival at 5 years is also improved by 18% between 2005 and 2009, having increased from 39% in 1990-1992 to 57% in 2005-2007, achieving good results especially in breast, prostate and colorectal cancer.

The costs of cancer treatments: spending on cancer medicines has increased from around €1 billion in 2007 to €2 billion and €900 million in 2014. Average treatment costs have increased since 1995, in fact, the average daily cost of an antineoplastic has risen from 42.20 euros (1995-1999) to 203.47 euros (2010-2014), while the average cost of an overall drug therapy has increased from 3,853 euros in the period 1995-1999, €25,675 in the period 2005-2009, up to 44,900 euros during the period 2010-2014.

Access to care and home care: between 2008 and 2013, Italian cancer patients had to wait about 427 days to access the new drugs, as against 109 in the UK, 364 in France and 80 in Germany, with further regional differences. The report also states that "the activation of home care at the same time as resignation is carried out only for 48.1% of patients, for the remaining 51.9% the family members actually provide" and often the family can no longer compensate for the shortcomings of the system.

The patients' point of view: 35.2% of Italian patients think that the availability of drugs guaranteed by the NHS is insufficient, 53.8% of patients think that having personalized innovative therapies available is a priority, 78.8% think that "too many drugs for serious diseases are borne by patients" and 83% that the ticket penalises patients, while 75.7% of caregivers highlight the presence of disparities at the territorial level and 74.4% complain of economic constraints on the provision of innovative care.

The current propensity to consider "cancer" synonymous with "death" finally begins to lose ground thanks to the continuous arrival of new therapies and, according to the FAVO, "overall, one in four cancer patients can be considered fully cured."[1] The ageing of the population and the modern lifestyle, the increase in survival obtained thanks to the use of new drugs and therefore the chronicization of pathologies, the cost of innovative medicines, are the factors that, integrating with each other, are giving rise to a sick Italian population, which remains so for longer and which translates into high and increasing unit costs. The arrival of new therapeutic solutions, of undoubted value to patients, would therefore seem to have given rise to a particular situation from which it is not possible to free one another without a profound cultural change and spending management, which often continues to be based still on principles that now appear obsolete and anachronistic. It is clear that the arrival of innovative medicines is profoundly changing the dynamics to which doctors and patients are accustomed, and for this reason it is necessary to focus more on the empowerment of citizens, on a new culture of the management class and, consequently, on forward-looking resource management, the ultimate aim of which is not to achieve savings in the short term.

[1] FAVO, 11th National Day of cancer patients, 2016


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