Difficult decisions about funding new developments in healthcare have always existed. Medical breakthroughs are welcome and will continue to pose funding challenges. But objective, robust and transparent methods to assess cost effectiveness must be agreed and adhered to in the interest of fairness and equality.
The current controversy over funding for two cancer drugs differs from previous decisions: it could involve withdrawing treatment from dozens of cancer patients who are already benefiting from the expensive drugs. In the case of one drug, Pembrolizumab, the medication has already been through an objective assessment of its benefits and been found to be a cost effective treatment by the National Centre for Pharmacoeconomics (NCPE).
This decision notwithstanding, it has yet to be approved by a Health Service Executive (HSE) drugs committee and it now seems that politicians are to make the final decision as to which patients will get new treatment breakthroughs and which disease areas will not have novel therapies funded in future.
Pembrolizumab, a drug for advanced cancer that works by stimulating an immune response against tumours, is expensive. The five-year total cost of the drug as a first-line treatment for melanoma alone has been estimated at €63 million.
It and a sister drug, nivolumab, had been made available to some patients by the manufacturers MSD and Bristol Myers Squibb under an early access scheme. However it was flagged that this scheme would close after one year. Despite this, the HSE's drug-funding committee has not met since March and the NCPE decision to approve Pembrolizumab has been left in no-man's land.
Drug manufacturers also face questions. In addition to the sky high expense of novel treatments, which companies will defend on the basis of steep development costs, offering early access to these drugs on compassionate grounds to a limited number of patients could be seen as a clever marketing decision.
This controversy is ultimately about healthcare rationing. We urgently need to engage in a national debate about the controlled distribution of scarce resources – and one that is wider than the issue of approving expensive new drugs.
Until then the rigorous health technology assessments carried out by the NCPE and the Health Information and Quality Authority represent the only logical basis for making difficult decisions about the cost effectiveness of novel medical treatments.
We must follow the lead of Britain and not facilitate special compassionate access programmes to life-saving drugs. Their limited life-span is ethically questionable and inherently inequitable.
Simon Harris is right to question the appropriateness of a Minister for Health as the ultimate decision-maker in these matters. Politicians are the least qualified to make treatment decisions.