Sir, – As Irish haematologists with expertise in the treatment of the blood cancer multiple myeloma, we feel compelled to highlight the growing inequity with respect to access of Irish patients with this condition to potentially life-saving medicines.
Multiple myeloma is one of the success stories of scientific discovery, drug development and clinical trials in cancer over the past 20 years. From a position where the life-expectancy of most newly diagnosed patients was less than three years, 25 years ago, survival beyond 10 years is now possible in a good number of patients up to the age of 65 to 70. Year on year international data show continued improvements in the survival and quality of life of multiple myeloma patients with many able to return to work and make productive contributions to society. Up to relatively recently, as new active drugs received regulatory approval we were able to provide these in a timely and appropriate manner to our patients, the result of which is that the survival of Irish myeloma patients was on par with anywhere in the developed world.
However, in the past few years this situation has changed utterly, alas coinciding with the introduction into the clinic of truly transformative medicines for multiple myeloma, which have gone on to receive full regulatory approval in the US and Europe. Having been top of the class, Ireland now risks slipping to the bottom in terms of patient survivorship because of a lack of political leadership and an overly bureaucratic, opaque drug reimbursement system that is clearly not fit for purpose. We are not unaware of the financial pressures on the healthcare system and have until now done our best to work within the system and respect prescribing restrictions. But as advocates for our patients we feel that we can no longer stay silent. Our experience, supported by robust international evidence, is that early access to these drugs is vital in terms of further improving patient survival. Delays in reimbursement of several years following drug approvals are increasingly common, and Ireland is now in the unenviable position of being one of the few countries in Europe where many drugs and drug combinations are not approved. A case in point is the drug Daratumumab, which despite overwhelming evidence of benefit when used in combination for the treatment of early/first relapse, is not approved in Ireland in this setting.
As per a 2016 agreement with the Irish Pharmaceutical Healthcare Association, Ireland uses 14 countries as reference countries for pharmaceutical pricing and reimbursement. All, bar one, of these countries provide access to Daratumumab combinations in patients with first relapse. What adds to the inequity is that in certain cases, Irish patients with insurance are able to avail of these treatments in private hospitals.
We urge the Minister for Health and those responsible within the Department of Health, HSE and relevant agencies to fix this problem as a matter of urgency. – Yours, etc,
Prof MICHAEL O’DWYER,
Consultant Haematologist,
University Hospital Galway;
Dr SIOBHAN GLAVEY,
Consultant Haematologist;
Beaumont Hospital, Dublin;
Dr VITALIY MYKYTIV,
Consultant Haematologist,
Cork University Hospital.