CANCER AND PRESSURE-RELIEVING TRENDS
There are a few trends potentially relieving pressure. Firstly, older drugs when they come off patent usually plummet in price, often by up to 95%. Secondly, if the improvement in outcome is large enough, there may be compensatory savings in other health costs, though the expenditure is now and the savings are later and may be hard to trace (and may even accrue to another healthcare provider). Thirdly, better predictors of disease behaviour may allow us to target our expensive therapies on those most likely to benefit. For example, if we knew which breast cancer patients would be cured by surgery alone (the majority), we could save a huge proportion of our adjuvant therapy drug costs. Research into such predictive biomarkers is one of the hottest areas in cancer at present for this reason. Research into new clinical trials methodologies may also help to reduce development times and thereby drug costs.
How these factors play out, in the coming years, remains to be seen, and it is likely that different solutions will emerge across the globe. Within Europe, we are likely to see the principle of universal coverage for state-of-the-art care increasingly slipping. The picture in the UK where NICE decides on affordability is likely to become more widespread as a model for decision-making, despite the problems experienced by NICE operationally. This then raises the linked issue of top-up funding, already a political hot potato in the UK. Private insurance to top up state provision may also become more the norm as the costs are much lower than for policies aimed at replacing state provision. In the USA, a major issue of partial coverage remains. Even for those with insurance, I suspect we will begin to see some attempt to limit expenditure on the most expensive cancer therapies. Outside the major Western economies, we are likely to see cancer incidence rising as life expectancy improves with economic growth. The best-value cancer therapies are surgery and radiotherapy, and we are likely to see a growth in these services in developing economies. The extra gain from drug therapies is relatively small, so access to these is likely to be more restricted to cheaper, older drugs, with the most expensive therapies confined to a small minority in these countries.