Equity and solidarity in EU healthcare systems: Facts and myths. What are the potential hurdles in accessibility to innovative cancer care in Central Eastern European (CEE) countries?
This interesting workshop deftly moderated by Peter O’Donnell of POLITICO was focussed on the topic of access to new cancer treatments in Central Eastern European countries. He began by describing solidarity as a core value of the EU and asking if this should then be applied to improving access to medications in less wealthy countries. Cancer care in particular is notoriously expensive and many of the relevant medications are difficult to fund in some of these EU states with lower GDP levels. Looking at this form of health inequalities perspective it is notable that the states that can least afford these drugs are known to have higher rates and higher mortality from many cancers.
Moderator Peter O’Donnell of POLITICO with YFG Scholars
Nora Cooke O’Dowd and Patrick O’Donnell
The MEP Alojz Peterle, president of the MEPs Against Cancer (MAC) group in the European Parliament and himself a cancer survivor, then opened contributions with a video message www.europeancancerleagues.org/mac.html. In it he passionately explained that cancer is not only a health issue, but it also has major social and political implications. The MAC group work to keep cancer high on the agenda in the parliament and EU institutions. They aim to have MAC affiliated groups in all member states pushing the same agenda nationally. Interestingly Mr Peterle also cited the Lisbon Treaty when explaining that adopting a Health in All Policies approach to cancer, there needs to be more financial support for research and political will to tackle this condition.
Federico Paoli, a policy officer at European Commission, again stressed that solidarity, equity and access are key goals of the Commission in relation to health. He explained a relatively new process whereby the European Semester process is used to advise certain countries to improve access healthcare for their people http://ec.europa.eu/economy_finance/economic_governance/the_european_semester/index_en.htm. At present there are no sanctions used for member states that do not follow this advice. The Commission is also looking at ways to improve health technology assessments (HTAs) and streamline their use across all states and also at how accessing cross-border healthcare could be used more widely.
Ananda Plate of the umbrella group Myeloma Patients Europe explained their innovative approach her organisation has developed to systematically gather evidence for advocacy and information purposes www.mpeurope.org. Previously groups like these relied on much anecdotal evidence. Myeloma Patients Europe is launching their ATLAS approach at the end of 2015 and this will provide a much more robust and interactive evidence base addressing certain diseases. This may be adaptable for other conditions and diseases.
Martin Price of Jannsen then spoke from the industry perspective. He reminded all present that cancer incidence is predicted to rise hugely across the EU in the next decade and that there is a correlation between investment in treatments and survival rates. As a representative of a company that develops medications for cancer, he explained that the process of bringing a new medication to the bedside is complex and costly. Evaluations and appraisals often have to be carried out in each country and these can vary from efficient exercises to long and convoluted delaying mechanisms. He speculated that HTAs are used to restrict spending and control costs in some national health systems, thereby restricting access to important new drugs. He did admit there is a major trust issue between pharmaceutical companies and other stakeholders in this process of bringing a drug to patients. “These delays cost lives” and “people die” was how he summed up his position on the status quo when it comes to cancer drugs.
Last to speak was Professor Maciej Niewada of the Medical University of Warsaw. He discussed a recent report he has published on this very subject. He has shown that the percentage of GDP spent on healthcare in CEE countries tends to be the lowest in the EU. When he mapped out 30 sample cancer drugs there were relatively new to markets, again few of them had been made available in the CEE countries compared to the more western EU countries. He also reported that there were significant delays between a medication being authorised by the European Medicines Agency and it being made available in these same countries. There seemed to be many hurdles in the HTA process applied to these medications that contribute to these time lags.
Overall, this debate was quite interesting with contributions from many of the key stakeholders in this complex area. Cancer treatment is always emotive and challenging to research and manage as it is quite often a ‘life or death’ situation. It is obvious that patients living in the CEE countries are at a major disadvantage at present when it comes to cancer treatment and solutions should be looked at a on a national an pan EU level.
This Blog was written by the Young Gasteiner Patrick O’Donnell