Cancer inhibitors scrapped from basic insurance for some users

National healthcare institute Zorginstituut Nederland has scrapped several cancer-inhibiting drugs from the basic healthcare package for specific groups of cancer sufferers, saying they do not work and are putting too much financial pressure on the system.

The institute based its conclusion on new international research, which it claims showed that PARP inhibitors, which help repair damaged DNA, do not lead to a better quality of life or prolong life in people whose cancer is not linked to a genetic defect.

The inhibitors do work in women who have advanced or recurring ovarian cancer caused by the BRCA mutation and they will continue to have access to the medication. Patients who have already started treatment will be able to finish it under their current insurance.

Some 1000 people in the Netherlands use PARP inhibitors. The measure will halve that number and free up some €15 million for other healthcare purposes, the institute said.

It is the first time the Zorginstituut has partly removed expensive medication from the basic healthcare package based on a re-evaluation of its efficacy. Cancer medication costs currently account for 59% of the total spent on medication, or some €2.6 million, over twice as much as in 2012.

The rise in costs is not reflected in a significantly longer lifespan for cancer sufferers, the agency said.

The Dutch medical oncology association NVMO said it is in favour of reexamining the efficacy of medication in different groups of patients but said the new studies relied on by the Zorginstituut leave something to be desired.

“Some patient groups are not properly identified and are not properly included in the statistical analysis,” NVMO chairwoman An Reyners told broadcaster NOS.

“That means that there is effectively no proof the treatment works but there is equally no proof it doesn’t work. The risk is that some patients will not be getting the medication when they should,” she said.

According to institute director Lonneke Koenraadt-Janssen, it had been impossible to access more sources, such as practical data. “We had to rely on the available data which did not prove the PARP inhibitors work in these patient groups,” she said.

The decision, Koenraadt-Janssen said, was a hard one to make. “But we can’t delay these re-evaluations,” she said. “We have a healthcare system based on solidarity and it’s on the edge of going under because of the spiralling costs. You don’t want to spend millions on a treatment that has not been proven to work.”