Dr Deme KarikiosMedical Oncologist – Nepean Cancer Care Centre, Nepean Hospital

Clinical Lecturer – University of SydneyAlmost no longer a PhD student – NHMRC Clinical Trials Centre

Member of ESC of PBAC Chair of Oncology Drugs Working Group for MOGA

Global/US costsAustralian costs Why are costs (prices) of anticancer drugs rising?What are patients in Australia paying for anticancer drugs?

Not discussing value

Source: Memorial Sloan Kettering Cancer Center

JNCI: Journal of the National Cancer Institute, Volume 109, Issue 8, August 2017, djx173, https://doi.org/10.1093/jnci/djx173The content of this slide may be subject to copyright: please see the slide notes for details.

19% average

increase per year

PBS expenditure on anticancer drugsKarikios et al. IMJ (2014)

Efficient funding of chemotherapy (introduced Dec 2011)

Introduction of generics (Docetaxel)

Price disclosure (progressively reduces price of some PBS listed medicines which are subject to competition)

7% 11%

32%

Increasing incidence (aging population) – more individuals treatedIncreasing number of available drugs – new drugs added rather than replace existing drugsNewer drugs – used for longer- more tolerable (broader eligible population)- more effective

Little incentive for research into cheaper alternatives

PRICES

Cost of development/researchIndustry aims to attempt to recoup marketing/business costsCommercial imperative to maximise profitsUnited States What the market will bear (not value based pricing) Incentives for oncologists to prescribe the more expensive option

Karikios et al. IMJ (2017)

Rejection rate for initial submissions:54% (2005-09) vs 70% (2010-14); p = 0.04

Karikios et al. IMJ (2017)

$40.30 per prescription Safety net ($1550)

$6.50 (concession card holders) Safety net ($390)

Unfunded anticancer drugs?

The median out-of-pocket cost that oncologists estimated their patients had paid or were expected to pay, for treatment with an unfunded anticancer drug was

$7500 [$200 - $100,000]

Improving our understanding of how individual patients and their doctors think, communicate, and decide about expensive treatments

This could help minimise financial harms that are unexpected and/or unnecessary

The impact of out-of-pocket costs and financial toxicity in Australia

More than 50% of patients report a reduction in their household income after diagnosis of cancer.

One in 3 patients reported ceasing work or retiring as a result of the diagnosis of cancer and/or it’s treatment.