Editorial: We must put our trust in Pharmac

The Labour party has expressed support for funding of the melanoma drug. Photo / Mark Mitchell

Editorial

Government should consider carefully before intervening in drug body’s rational cost-benefit analysis.

Pharmac is possibly the most publicly respected body in this country. Protesters took to the streets at the mere suggestion its ability to drive hard bargains with pharmaceutical manufacturers might be compromised in the recently concluded Trans-Pacific Partnership trade negotiations. "Big Pharma's" occasional lobbying attempts to change Pharmac's remit only reinforces our confidence in the professionals who decide how our taxes can be spent for medicines of most value.

Theirs is an invidious task, never more so than this week when it had to tell us it would not fund a drug for melanoma, Keytruda, that is being hailed as a breakthrough in the treatment of this cancer. Clinicians say it is the only treatment that seems to be effective against advanced inoperable melanoma. Chemotherapy and other regular cancer treatments are not.

Keytruda is state-funded in Australia and England but here Pharmac's assessment committee has marked it low priority for funding, because of uncertainty about its benefits and extremely high cost. A course costs around $300,000, which anyone given a terminal diagnosis would pay if they could. Some can and do. But it is beyond the means of most and beyond Pharmac's budget when it weighs up all the demands on its funds.

There was a hint yesterday that the Government could come to the rescue. "Watch this space," said one of its MPs, Judith Collins, on breakfast television. She compared it to the breast cancer drug Herceptin, that was not accepted for funding by Pharmac but in 2008 the National Party promised to fund it if it came to power, and duly did so. Pharmac does "a great job", said Ms Collins, "but every now and then something comes along and you've just go to say, something has to give on this".

The Labour Party had been even quicker to take the decision out of Pharmac's hands. "We would fund it," said its health spokeswoman, Annette King. With politicians like these, who needs professionals to assess efficacy against costs?

If a Government provides additional funds to cover the costs of a particular drug, it does not upset the careful decisions that Pharmac has to make about the best use of its budget. But each time a Government does so, it reduces the integrity and fairness of the public health system. It is easy to make emotional decisions, especially where cancer is concerned. And of all cancers, melanoma may be the most scary.

New Zealand has one of the highest rates in the world, which is not surprising when we consider the clear skies and bright sunshine we enjoy, and the years when we were under an ozone hole in the atmosphere. Few of us may be free from worry about sunburns long forgotten and skin signs we have ignored.

If melanoma spreads to internal organs the median survival rate after diagnosis is nine months. Only 15 per cent of those diagnosed live for another three years. After two years of trials of the new drug, which enables the body's immune system to fight cancer cells, 60 per cent of patients in the trials are still alive.

It is easy to share the excitement of patients and clinicians and join the clamour for this drug to be funded at any price. But we ought to trust Pharmac to make the right decision.