Herceptin, Practicing Due Diligence

“For the dollars in your program budget, you want to make the biggest difference possible”. This statement, according to the Sunday, July 18/06 Calgary Herald, was made by Dr. Tony Fields, one of the Vice Presidents of the Alberta Cancer board. This clearly states that there is a finite amount of money budgeted for cancer drugs in Alberta, and decisions are made as to what cancer therapies are covered; in other words, not all effective cancer therapies are covered. The above statement was made by Dr. Fields as Alberta deliberates as to whether the breast cancer treatment drug will be covered. I wonder how many lay people understand the significants of his statement. Please don’t misunderstand me, I think the statement is true and the people who are asked to decide “what drugs will make the greatest difference” within the confines of a finite budget have a horrendous job. Basically, a conscious decision has to be made between which cancer treatments will be included and which will be excluded. What we all need to be asking, and what we all should be told, is on what basis are these decisions being made?
Let us take a practical example. If you are one of a hundred people annually in Alberta who are diagnosed with a certain uncommon form of cancer, and the treatment of this cancer is $100,000.oo per person, it would cost the Alberta Cancer Board 10 million dollars a year to take on this coverage (let us say that research shows the drug extends life expectancy by four years). At present, the board is budgeted to cover a more common form of cancer (1000 diagnosed in Alberta per year) at a cost of $10,000.oo per patient, and this has been shown to extend the life of this group of patients two years on average. The cost to the Cancer Board of this last group also is $10,000,000.oo and results in 2000 patient years. The first treatment group only yields 400 patient years for the same ten million dollars. On a fixed budget, the Cancer Board would likely be justified in rejecting the first treatment, even though it adds four years to the patient’s life if it required a discontinuation of coverage for the second group. The Question NOW becomes; Will you be told that there is a drug available that could add four years to your life but is not covered in Alberta for financial reasons, or will you be told the drug hasn’t been tested sufficiently at this time? After all, not paying for a drug that can add four years to the lives of 100 Albertans is a poke in the eye of the Alberta government and the Alberta Cancer Board from a political perspective.
Herceptin IS expensive and impacts a LARGE number of people annually (breast cancer patients). So if the Alberta Cancer Board pays for it, what other drugs will NOT be included in their coverage as they practice “due diligence”?
The problems in cancer treatment reflect the problems in our health care system as a whole. Costs continue to rise as treatments improve, decisions (which we are not a party to) are being made to control costs, and patients are not fully informed as to the basis of those decisions. Since we are not fully informed, we are not fully aware of our options. Not being fully aware of our options can lead to erroneous decisions on our part. Some people may feel that their life is worth twenty five thousand dollars a year or more, but are not given a choice.