Over the past 10 years, we spent approximately €10 billion in the Netherlands on medicines for the treatment of cancer. In a number of patient groups, life can be successfully extended with these drugs. However, that does not apply to everyone. This is evident from an analysis by the Integrated Cancer Center of the Netherlands.
In 2012, a quarter of the total medicines budget was spent on oncolytics (drugs for the treatment of cancer), in 2021 this was just over half. Total expenditure on medicines in the Netherlands increased to €2.6 billion in 2021. More than half (€1.5 billion) of this was spent on oncolytics. Cancers for which expenditures were highest are hematological malignancies, followed by lung cancer and melanoma.
IKNL publishes the figures mainly to encourage dialogue. Prof. Dr. Valery Lemmens, member of the board of directors: ‘The social costs of these medicines are considerable, while healthcare costs are under pressure. We see that drugs do indeed work for some types of cancer, but we see little improvement in survival across the entire patient group, especially in the group of patients in whom the cancer has spread at the time of diagnosis.’
Deploy resources in a more targeted manner
According to Prof. Dr. Lemmens, this forces us as a society to look closely at the expenditure on oncolytics. ‘The number of patients with cancer is increasing, and we want to treat these patients as best as possible now and in the future. That requires more research. Sometimes remedies are just as effective if they are used for a shorter period of time or in a lower dose. Products that are now being developed for a large group of patients, while only a portion of them benefit, mean that many patients suffer unnecessarily from side effects. And it costs society more than necessary. The better we know who will benefit from a treatment, the more targeted treatment we can provide and the limited healthcare budget spent appropriately.’
Survival of hematological malignancies
Drugs are most often used in the treatment of hematological malignancies (such as leukemia, lymphatic cancer and multiple myeloma). Survival in hematological malignancies has generally improved. The increasing survival trends are related to the introduction of new medicines and improved use of treatment. The five-year survival rate of multiple myeloma increased proportionately the most: from 45 percent in 2005-2009 to 60 percent in 2015-2019.
Survival of metastatic cancer at diagnosis
In one in five patients, cancer has spread at the time of diagnosis. In 2012, the median survival for metastatic cancer was almost six months. In 2021 that will be more than seven months. Not all patients in this group are treated with (expensive) medicines. Some medicines only work in patients with a tumor with specific properties. And sometimes treatment is abandoned because a medicine has too great a risk of side effects in relation to the patient’s condition or life expectancy. It is not always possible to determine in advance who will respond well to a medicine: this requires more research.
However, the survival figures do show effects of the effectiveness of medicines. In melanoma, the introduction of immune and targeted therapy appears to be reflected in the increase in median survival of the total group of patients. Specific patient groups often benefit from new medicines. In the total population, the median survival from non-small cell lung cancer for the group of patients with metastatic cancer at diagnosis as a whole remained around 5 months, but medicines do have an effect for part of the population. In 2017 and 2018, new treatment methods for non-small cell lung cancer became available (immunotherapy and combination treatment with immune and chemotherapy) that result in a better prognosis. The median survival increased to 7.5 months, 17.7 months and 12.1 months, respectively, after treatment with chemotherapy, immunotherapy and combination treatment.
IKNL asked various people and organizations to reflect on the figures and/or the issue surrounding expensive medicines. Articles and responses from doctors, patient representatives, policy makers and researchers have been brought together in an online magazine, which includes more figures and explains the methodology.
To the magazine
On October 3, IKNL will hold an evening symposium on expensive medicines. The NFK, KWF, doctors and pharmaceutical companies, among others, reflect on the figures. Lemmens: ‘In-depth figures are important for many groups. Patients benefit when survival figures and side effects figures are tailored to their specific situation. Doctors want to know more about the drugs they prescribe. Insurers and the government will want to know more about the effect of oncolytics after admission to the market. And as a society we need to think about rising costs.” Partly as a result of the symposium, IKNL is working on a more extensive report that will be published in 2024.
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