Billion Bill for new cancer drugs – Bergens Tidende

Hospitals peaks have notified the Ministry of Health that new, expensive cancer medicines will crack hospitals economy.

– It is entitled and simply happened a miracle, says Ingolf Skadberg (66) and smiles happy.

For eighteen years ago fisherman from Egersund confirmed lung cancer that has spread. Operation was no use, and chemotherapy proved ineffective.

So did Skadberg offer to test a new drug, which should speed up the body’s own immune defenses. After half a year with immunotherapy the tumor in the lung shrunk to far less than half. The spread is the only remnants left.

Promising new treatment

PD1 inhibitors. You might as well learn name, you’ll hear it often in the future. PD1 inhibitors are drugs that help the body’s own immune system to fight cancer. Immunotherapy is promising new cancer treatment.

The medication Skadberg have tested, is one of two new PD1 inhibitors that are appropriate to impose against lung cancer has spread.

• Immunotherapy is the treatment of cancer in which the body’s immune system will help to self-dealing and kill cancer cells. Some medicines (as PD1) inhibitors block the brake pads between cancer cells and the immune system. This means that cancer cells can not evade the immune cells and cancer cells are attacked and die.
• Decision Forum has twice said no to the introduction of PD1 inhibitor nivolumab against lung cancer has spread before the impact is assessed against the award.
• Two large studies show that nivolumab gives median patient three months extra life. About one fifth achieve prolonged survival, ie two years or more. It’s better numbers than treatment with chemotherapy.

The problem is the price of these new medicines. Treatment with new PD1 inhibitors costing 1.1 million annually. Most recently this week said Decision Forum refusal to introduce PD1 inhibitor nivolumab before Medicines Agency has considered whether the effect is good enough to justify the high price.

Also read: Immunotherapy tested at Haukeland

The professionals in the Norwegian Lung Cancer Society believes that the results for nivolumab is so good, that the medication immediately should be used.

In Decision Forum sitting directors of the four health regions. In September the forum to ask the Ministry of Health involved in the question of how hospitals to deal with the galloping rise in drug spending.

Price: Three billion

technical director Baard-Christian the Scheme in Health Vest has a note warned their counterparts in Decision Forum that several similar cases are underway. PD1 inhibitors may be appropriate for 20 different cancers.

PD1 inhibitors will cost the Norwegian health care between 2.5 and 3 billion annually, given that these medicines administered to 3,000 patients annually, it says in the note .

Lung cancer is a large group of patients. As many as 1,500 lung cancer patients annually are appropriate for PD1-treatment. The medication these patients are currently costs 10,000 kroner annually.

– These new medicines represents a wonderful and very welcome development, but we can not confirm that they are used, without regard to the consequences, says the Scheme.

– Dramatic consequences

Decision Forum is the national body that make new medicines and methods standard in Norwegian hospitals. Schem recalls that the forum is required to be neutral in relation to the diagnosis.

– We can not concern ourselves with what disease the medicine is working towards. Our goal should be that the funds we get from our politicians should provide the greatest possible benefit to the entire population, and be most fairly distributed among populations, he said.

Read also: Price to Bergen cancer researcher

To increase spending on a range means cuts on others.

– To say yes to new billion spending overnight will have dramatic consequences for other patient groups, he added.

– Hopes for better and longer life

Section Chief Øystein Fløtten at Haukeland University Hospital has no trouble seeing the high price makes the introduction of PD1 inhibitors to a dilemma.

Medical is immune therapy a major advance.

– For cancer patients, these new medications hope for a better and longer life, he said.

– Can they be completely healthy?

– I think we really do not. But for a small proportion of patients the effect is good and stays throughout the observation period, which currently is two years, says Fløtten.

When it comes nivolumab is NOMA started with the systematic review, which is expected around year end. When the question comes up again in Decision Forum.

Paying yourself

Some do not have time to wait so long. TV 2 has a series of stories told about Svein Ulset from Bergen who are now paying for nivolumab treatment at private clinic Aleris.

– For me it is an unacceptable question in the sense that they should spend time to find this out, I’ll die in the meantime. I will not survive a year or half a year, he said to TV 2.

– You know me fine

Ingolf Skadberg have plans that extend far into the future. Fishing does he continued, and in the winter there will be another trip to Gran Canaria.

– I have not taken time to think much of life expectancy and such. The days at sea has been busy, he said.

– You know you well?

– I’ve been short of breath, especially in the past, but now receive medicines to help prevent it . Otherwise I feel absolutely fine, says Skadberg.

Høie requires industry

Health and Human Services Bent Høie see that many hospitals are struggling when new and expensive drugs are approved and should be offered patients. This has led to a greater burden on hospitals economy than population trends would imply.

– This drives costs up, and it’s one of the reasons why we have chosen to increase hospitals’ budgets in recent years, says Høie.

Read also: When the principal got cancer

He is keen to set standards for the pharmaceutical industry.

– The pharmaceutical industry will not be able to dictate prices. We should be able to negotiate the price and know that the treatment effect is documented before taking new medications in use, says Høie.

It should also be equal treatment by all the country’s hospitals.

White Paper

After Christmas he will deliver a white paper, where these priorities are included.

– There is no doubt that medical breakthroughs can treat patients and provide better results than before. Especially new medicines that provide life-prolonging treatment to cancer patients, says Høie.

Haukeland University Hospital has seen medicine expenditure increase for several years. New cancer drugs are costly, but also other biological agents weigh in the accounts.

More expensive medicines

For nearly 10 years ago, hospitals are required to pay for a variety of biological drugs that patients use without to be admitted. H-prescription scheme concerned first new rheumatic drugs and was then expanded to apply multiple drugs against MS and 2014 some cancer drugs.

The costs have exploded. Last year H-prescriptions almost half of hospitals’ expenses for medicines. When cost H-prescriptions hospitals two billion crowns.

Also read: Høie opened prostate center

Haukeland University estimate that the final bill for H-prescription schemes in the year ending in just under 190 million . Last year it sounded at 170 million.

– A conservative estimate says that the new PD1 inhibitors against lung cancer will cost us 30 million annually, says technical director Alf Henrik Andreassen.

– How handles hospital such an expense?

– Should we use 30 million for new cancer drugs, we must give priority to other areas of hospital operations or other patient groups. Naturally we will deal loyally with national decisions, but such decisions must come along with money to take costs, Andreassen says.