Cancer drug coverage extended

Posted on November 30, 2009 in Health Debates – health/ – Cancer drug coverage extended
November 30, 2009.   Denise Balkissoon, Jim Wilkes

Ontario cancer patients who were once forced into mortgaging their homes or emptying savings accounts to pay for an effective but pricey drug have just had provincial coverage extended.

Avastin, which costs $1,750 per treatment for colorectal cancer, will now be covered for 24 cycles instead of just 16, an about-face that comes two months after ombudsman André Marin blasted Queen’s Park for the short cut-off period.

In the past, costs have been as high as $3,000 per treatment.

“It is a very expensive drug,” said Health Minister Deb Matthews, announcing the extension. She said the province had been in cost discussions with Roche, the drug’s manufacturer, since May. “Bringing the cost down gave us flexibility to lift the cap.”

Last year, Ontario spent $11.5 million on Avastin. The province’s tab will increase by $5 million over the next year, said Matthews, with $3 million of that due to an increase in patient numbers, and $2 million due to the new coverage.

“It was very difficult to tell a patient who was benefitting, `You know, we can’t give it to you anymore,'” Dr. Malcolm Moore, chief medical oncologist at Princess Margaret Hospital, who works with the drug in clinical trials, said Sunday.

Although most people stop responding to chemotherapy after eight months, Moore has seen Avastin work effectively for over a year. The health ministry says on average Avastin, used with other chemotherapy drugs, extends lives from 15 months to two years.

On Sunday, Marin said the government’s decision to end the hard cap for Avastin was “long overdue.”

His September report, “A Vast Injustice,” was highly critical of the 16-cycle limit for the drug.

“Regrettably, this situation verges on cruelty for those already afflicted by this unrelenting illness,” Marin wrote in his report. “It is apparent that the 16-cycle cap applying to Avastin in Ontario is a factitious barrier unsupported by clinical evidence or medical practice.”

Avastin does not cure colorectal cancer, but is highly effective in shrinking tumours by cutting off blood supply. Marin said stopping treatments can allow tumours to resume growth or even spread more quickly.

“Some studies show there’s a boomerang effect, where it can actually accelerate the rate of cancer,” he said. “When you have a drug that’s working … you just don’t cut it off.”

Former health minister David Caplan had responded to Marin’s report by saying he needed more “medical evidence.”

Individual treatment will be assessed every 12 cycles, said Matthews, depending on whether patients are stable and their cancer responsive. Some would be eligible even beyond the new 24-cycle cut-off.

Before Ontario’s July 2008 approval of Avastin as a colorectal cancer treatment, patients paid entirely out of pocket for the drug, including Esther Hart, the subject of a Star story several years ago.

Fundraisers helped Hart come up with the $40,000 annual cost of Avastin. She did eventually die in 2007 of the disease at 39, but had lived for two years after the initial diagnosis of stage-four cancer.

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