8 June 2023 – Te Pātaka Whaioranga – Pharmac has started consulting today on proposed changes to the funded intravenous breast cancer medicine, trastuzumab. The proposal would see the main funded brand of intravenous trastuzumab change from Herceptin to a biosimilar trastuzumab called Herzuma from 1 December 2023.
The proposal would also give around 100 New Zealanders with stomach (gastric) cancer funded access to intravenous trastuzumab every year.
Cancer Society spokesperson Lucy Elwood says the Society understands the rationale behind the decision and welcomes the funding of trastuzumab for gastric cancer, but is disappointed that through its procurement process Pharmac didn’t consider funding subcutaneous trastuzumab treatment, as the treatment can be given by injection under the skin and able to be administered close to home, as opposed to an infusion which is administered by IV in a hospital.
“We get that Pharmac needs to look for cost savings. So, the logic of switching from intravenous Herceptin to the biosimilar intravenous Herzuma stacks up, as Herzuma has gone through rigorous testing.
“However, we’re disappointed that through the process Pharmac didn’t consider funding subcutaneous administration of trastuzumab. We see the potential for cancer treatments by injection to allow many cancer patients to have their treatment closer to home. We believe funding subcutaneous treatments would have the potential to significantly improve rural inequities, and significantly reduce the capacity burdens on our stretched hospital system.”
The Cancer Society’s Nelson-based medical director Dr Kate Gregory specialises in breast cancer care and frequently sees patients who travel to and from Golden Bay for treatment.
“For many of my patients each one of their trastuzumab visits will take up over half a day. Most will put aside a full day,” she says. “In comparison, sub-cutaneous trastuzumab treatments could be reduced to a 10-minute visit to their local GP. Across a full year of treatments there would be substantial hauora benefits to these patients from having cancer care closer to home.”
The Pharmac consultation and decision about Herzuma is only looking at how to save the health system cost for a treatment that’s already available, and misses the opportunity to look at broader health outcomes Ms Elwood says. In comparison, funding subcutaneous trastuzumab would be “a game changer”.
“We’re disappointed that this consultation does nothing to close the ever-growing medicine gap between New Zealand and other countries we compare ourselves to like the UK, Canada and Australia.
“For comparison, the UK first announced funding for subcutaneous Herceptin in 2013 on the basis that it would free up specialist cancer nurses and hospital pharmacists given rising pressures on chemotherapy facilities ; minimise waste and overall drug costs because the subcutaneous form of Herceptin is given as a fixed dose not dependent on patient size or weight; is a much less invasive treatment; and has the benefit for patients of less time receiving treatment.”
When the Cancer Society asked Pharmac late last year to consider subcutaneous trastuzumab it was advised that it was still under assessment and out of scope of this particular procurement process. This provides Pharmac with the flexibility to list subcutaneous trastuzumab at any point in the future, “but that was nine months ago and in the meantime people living with cancer are still waiting,” says Ms Elwood.
To close the medicine gap the Cancer Society will keep advocating for Pharmac’s budget to be increased and for medicine funding decision-making processes to consider broader equity considerations.
Consultation on Pharmac’s proposal closes at 4 pm, Friday 30 June 2023. More information is available at: https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/2023-06-08-proposal-to-widen-access-to-intravenous-trastuzumab-and-change-the-funded-brand/