The fight between pharmaceutical companies and health authorities when it comes to negotiating prices is delaying the incorporation of some useful cancer treatments. The problem lies in the pricing system and the lack of transparency about the research, development and production processes of new drugs. Public spending on cancer treatments has doubled in just five years, and therapies for rare diseases have grown by more than 66%. Both items already represent half of all hospital pharmaceutical spending and 20% of the item that the National Health System allocates to medicines, which amounts to 20,000 million euros per year.
If we take into account that in 2016 the percentage was 15%, the data shows an escalation that may become unsustainable in the current budget framework. Some of the new treatments have provided curing options for tumors with a very poor prognosis but, overall, the increase in costs has not translated into an equivalent global therapeutic improvement. In the time that spending on cancer drugs has doubled, the survival of cancer patients five years after diagnosis has barely improved three points: from 52% to 55% in men, and from 59% to 62% in women, and some of that improvement is due to other factors, such as earlier diagnosis.
The health system must review the causes of this growing mismatch between price escalation and therapeutic results. The experience of recent decades indicates that very few drugs provide truly disruptive improvements. Most represent very limited improvements in survival rates, which does not prevent the prices set from being very high. The problem is that at the time of its approval, the evidence on its long-term effects is insufficient and, in fact, international studies indicate that more than half of the new cancer treatments do not provide substantial improvements in the medium term.
The industry demands that medicines be paid according to the value they provide, regardless of the cost of obtaining them. With this strategy, it seeks to amortize the investment made in the shortest time possible, recover the costs of other failed investigations and obtain the maximum possible profit. With these premises, the British health system will pay 3.5 million euros for each treatment of a new drug against a rare genetic disease. The problem is aggravated when the potential beneficiaries are many. The latest versions of Car-T therapy for hematological cancer are paid at a rate of 380,000 euros per treatment.
The National Health System cannot be held hostage to a logic that leads to increasingly exorbitant prices, which constantly exceed forecasts. Many countries are already applying containment criteria that include variable remuneration based on results. In Spain it is also applied in some cases, along with other mechanisms, but for the moment they are not managing to stop the escalation. It is important to establish a pricing system that allows rapid incorporation of new therapies at reasonable prices adjusted to the costs of obtaining them.