Mind the gap - an analysis of cancer medicines in New Zealand and Australia
When it comes to making a difference in people’s lives, it’s not about how many medicines you have, but having the ones that work.
On this page
This has been backed up by a study published in the Seminars in Oncology journal. The study, Mind the gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand, comparing cancer medicines access in New Zealand and Australia – shows that more medicines don't automatically mean better health outcomes.
- Mind the gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand(external link)
- Mind the gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand [PDF, 2.2 MB]
- Accompaning editorial: The high cost of ignorance in oncology(external link)
- PHARMAC media release: Quality over quantity more important in health outcomes
Summary of the research
The animation below simply explains the results of the study, and why the results are important for all New Zealanders to consider.
Objective of the research
The Mind the Gap research, was commissioned by PHARMAC in response to reports that suggested access to fewer cancer medicines in New Zealand results in poorer health outcomes. It looked at the health benefits of cancer medicines funded in Australia compared to those funded in New Zealand, to see if there were any clinically meaningful benefits that New Zealanders were missing out on.
The findings of the study showed:
- There are 89 cancer medicines that are funded in both New Zealand and Australia.
- There are 13 cancer medicines that New Zealanders have access to, that Australians don’t.
- There are 35 cancer medicines that Australia has funded, that we don’t.
Out of the 35 not funded in New Zealand, only three provide real, meaningful benefit. PHARMAC has already funded one of these, pertuzumab for breast cancer, and is considering funding applications for the two others.
A further 17 medicines provide only moderate or poor benefits, and five potentially caused harm or worse health outcomes compared to currently funded treatments in New Zealand.
Should New Zealand fund the same cancer medicines as Australia?
New Zealand spends $130m annually (gross cost) on its cancer medicines. Careful selection of these medicines has enabled us to avoid additional costs of at least another $130 million each and every year, much of which would not help people with cancer any more than at present. The research shows that, with only three exceptions, those unfunded cancer medicines offer little, or relatively low, clinically meaningful health gain.
What is a clinically meaningful health gain?
The study looked carefully at how much benefit there would be for patients taking the medicines available in Australia, but not in New Zealand.
To compare the relative benefits of medicines, the study used internationally recognised measures: progression-free survival (PFS) and median overall survival (OS). Benchmarks, independently set by the American Society of Clinical Oncology (ASCO), were also used.
The difference in these measures are important: the time you enjoy better health before the disease returns (PFS) might be superior, but you may die even earlier from the disease once it returns (OS). So it is important to understand both. There is an increasing trend in cancer research for studies to be stopped once PFS gains are shown; before the OS is known.
Overall survival vs progression free survival and surrogate endpoints
Included in the Mind the Gap study, is a graph (figure seven) that shows the changes in progression free survival and then incremental changes in overall survival, and whether progression free survival is a good predictor of long term benefit. Dr Matthew Strother explains why this is important:
What do others say?
The Editor-in-Chief of the Seminars in Oncology journal, Tito Fojo, MD, PhD, wrote about the study in his editorial "The high cost of ignorance in oncology".
Dr Fojo noted:
“.. thought-provoking contribution from PHARMAC in New Zealand. At a time when discussions about drug costs leads to agreement that “this trajectory is not sustainable” but provide no clear solutions, PHARMAC shows us what a society must do to deal with this problem. Benchmarking outcomes to the American Society of Clinical Oncology Cancer Research Committee (ASCO-CRC) recommended targets for clinically meaningful health gains has allowed PHARMAC to achieve “good value for money” and deliver the best health outcomes for all New Zealanders.
“This is a commendable, courageous endeavour that many can learn from and emulate – and if widely adopted could incentivize drug development to achieve truly meaningful outcomes”.