Is the price of innovative drugs an obstacle to ensuring that each patient receives the best care? The point on this debate launched in France in 2004 by the case of the treatment against Hepatitis C.
- The cost of treatment for serious illnesses such as cancer sometimes reaches hundreds of thousands of euros
- These high prices are explained by the cost of research for increasingly targeted treatments.
- Doctors denounce the slowness of the marketing process linked to these high prices and speak of loss of opportunity for patients
- The cost of these treatments should be weighed against the benefit for patients and its economic impact.
A “loss of chance” for many patients. The finding is serious. It was made public in the fall of 2018 through a column published in the newspaper Le Monde and signed by many oncologists denouncing the difficulty of providing their patients with access to innovative treatments, particularly in the management of cancers. bladder and lung. In question, the impossibility of prescribing drugs in direct connection with their too high price constituting an obstacle in the process of authorization of placing on the market.
The case of the price of innovative drugs had really burst in 2004 with the arrival on the market of a new treatment against hepatitis C. Price of the cure: 46,000 euros. Result, indignant patient associations and a standoff between the Economic Committee for Health Products (CEPS) which sets the price of drugs in France and the American laboratory. In the end, long negotiations which led to the obligation for this laboratory to return to Health Insurance part of the money spent to cover prescriptions from a certain threshold of patients treated and the decision taken by the Ministry of Health to cap the spending envelope for this disease. Measures which, added to the arrival of competing molecules, have contributed to reducing the cost of these treatments by nearly 40%.
Treatments that cost hundreds of thousands of euros
But the controversy over the price of innovative drugs is not over. Immunotherapy treatments in the management of cancer are also at the heart of the debate with costs that sometimes reach several hundred thousand euros. Astronomical sums but to be compared with a very significant increase in the survival of patients and their quality of life, a concept whose economic evaluation is obviously complex! “In the United States, we have just developed a treatment that corrects a genomic defect responsible for a disease that handicaps a lifetime. It consists of a single injection which completely cures the patient but the price of which is 2 million dollars… If we add up what the care of this patient would cost throughout his life, this is not so expensive ! “, explains Jean-Jacques Zambrowsky, doctor and health economist.
But if, on the basis of this type of reasoning, certain doctors judge that the price of innovative drugs is not an issue in access to care – “I don’t know of any patients who would not have access to care because of their cost”, affirms for his part Professor Guy Vallancien-, others denounce in this regard a serious dysfunction of our health system. In one debate organized by Fréquence Médicale on the occasion of the European Cancer Congress (ESMO) in November 2018 in Munich, professors Nicolas Girard (pneumologist at the Institut Curie) and Gilles Freyer (head of the oncology institute of the Hospices Civiles de Lyon), did not hesitate to speak of “regression” in access to care. “With the ATU system (temporary authorizations for use allowing access to the drug before the marketing authorization is issued, editor’s note) we can be in France among the first to have innovative treatments but we are blocked on drugs for which we find new indications”, lamented Gilles Freyer
Economic constraint on health expenditure
The main defendant in this case, the process which leads in France to the marketing of an innovative medicine and its reimbursement by the Health Insurance and in which the price can constitute a brake because of the economic constraint which weighs on health spending. “The ONDAM (national objective for health expenditure) was set up 25 years ago, before the emergence of the much higher proportion of chronic diseases today and the advances that allow much more targeted treatments in diseases serious, we should look at things from a different point of view, consider that health is a capital for a country and transform the health insurance system into a health insurance system that better integrates prevention and the benefits of innovative treatments ” , suggests Jean-Jacques Zambrowsky.
Alongside these French particularities, there is obviously also the question of the justification of the price at which the laboratories offer their innovative treatments. The idea circulates in the general public of abuse in this area against a background of demonization of “big-pharma” and its supposed super-profits. A thesis that Jean-Jacques Zambrowsky immediately relativizes: “The industry does not go too far, it is a risk industry in which the probability of failure is high, investments in an innovative treatment can reach 500 million to a billion dollars over 10 years and if this can sometimes lead to a jackpot, there are also a lot of clinical trials that do not succeed and we have to pay for the ability of the laboratories to take the risk of continuing their research”, emphasizes the Health Economist. Without forgetting that on the management of the most serious diseases, the advances of this research lead to the proposal of increasingly targeted treatments, in particular in cancer, which can only address a few tens of thousands of patients. . “We are no longer in the era of blockbusters when the industry was developing very widely prescribed molecules! confirms Jean-Jacques Zambrowsky.
A balance of power between industry and payers
So how to find the “right price” to ensure access to innovative drugs for all patients without causing an explosion in healthcare costs? “In the discussions on the setting of prices and the coverage by the Health Insurance, there is too often a posture of a balance of power between the industry and the paying agencies”, deplores Jean-Jacques Zambrowsky who hopes, after the statement on these subjects by the French government during the meeting of the CSIS (Strategic Council for Health Industries) in July 2018an “awareness allowing a more open and serene dialogue”.
And to cite the example of what finally made it possible in the case of treatment against hepatitis C to lead to a reduction in the price: “More and more health systems in Europe accept the principle which prevailed in this case, namely a form of risk sharing which leads the laboratory, when the treatment effectively demonstrates its usefulness and its effectiveness for patients, to return to the paying agencies part of the sums spent for its care. .
But Jean-Jacques Zambrowsky cannot help but deplore the fact that the situation is not changing very quickly in this direction in France, while acknowledging however the positive sign of the choices made in terms of health expenditure – “The ONDAM remains in advance on the pace of economic growth, which is already an enormous effort even if it remains insufficient” – and hoping, “even if we are slow to work on the efficiency of care” that an objective will be quickly achieved set by Bernard Kouchner when he was Minister of Health: not spend less but spend better.
Subjects made from the LEEM file “100 questions about medicine”
Find below the LEEM sheet: “Are innovative drugs really that expensive?”
https://www.leem.org/100-questions/les-medicaments-innovants-sont-ils-vraiment-so-chers
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