It could cost the State up to €500 million to provide public patients with wider access to innovative new cancer therapies in the same way health insurer VHI has for private patients, it has emerged.
Prof Michael Barry, who is charged with assessing the cost-effectiveness of medicines for the State, originally estimated the cost of wider access to the drugs for earlier-stage cancer patients at €100 million.
Now, however, he says the number of indications covered by the VHI initiative is 13, and not three, as appeared the case when news of the company’s decision emerged last weekend.
Consequently, the cost to the State of replicating the move could be as high as €500 million over five years, estimates Prof Barry, clinical director of the National Centre for Pharmacoeconomics (NCPE).
The VHI wrote last week to oncologists saying it would provide wider access to cancer drugs, including Pembrolizumab, for stage-three melanoma, and Pertuzumab for patients with early-stage breast cancer. The move is seen as disrupting the traditional equality of access for public and private patients for such treatments.
Prof Barry says the change raises questions of equity between public and private patients. However, the wider access will apply only to VHI patients in private hospitals, and not to private patients insured by the company who are being treated in public hospitals.
Minister for Health Simon Harris has described it as a commercial decision. He was not informed in advance that the State-owned health insurer intended to provide wider access for its subscribers to some cancer drugs than can not be availed of by public patients, "How could the Minister not have known this letter was coming when the Government is the main stakeholder in VHI?" Dr Derek Power, an oncologist at Cork University Hospital, asked.
Laya Healthcare and Irish Life Health, the two other health insurers in the market, say they have no plans to follow VHI's lead.
Before drugs are approved for public patients they must be assessed for cost effectiveness by the NCPE. While assessments are completed within months, the process of approving new drugs, or new applications for existing drugs, is often subject to lengthy delays within the HSE.