The cost of cancer care

€17million are spent each year for cancer care in Malta including oncology medicine introduced in the Government Formulary, which has seen gradual additions since 2017. Malta’s National Health Service had already taken a great leap forward back in 2013 with the opening of the Sir Anthony Mamo Oncology Centre, which to this day offers inpatient and outpatient services. 

Speaking to TheJournal.mt, our Health Department’s Chief Medical Officer Dr Denis Vella Baldacchino explained how “the need for innovative pharmaceutical treatment had long been felt, and several attempts had been made to introduce new medicines in the government formulary throughout the years. However, in an ad-hoc manner, and although basic oncology treatment was made available, more advanced treatment was not accessible”. This was also a time when patients requiring such treatments relied on family savings and loans to pay for their treatment or even turned to financial aid from the Malta Community Chest Fund. 

Between 2014 and 2015, however, an ambitious proposal was drawn up showing the dire need for the funding of first and second-line treatments for the most common of cancers in the Maltese Islands (breast, prostate and colorectal). Drafted upon the initiative of Chris Fearne, then Parliamentary Secretary, Dr Vella Baldacchino himself as CMO, and several Oncologists, Haematologists and Policy Pharmacists, the proposal was eventually approved by Cabinet and a €3million sum was promised in the Government’s following budget. 

€17million are spent each year for cancer care in Malta including oncology medicine introduced in the Government Formulary

Now, through requests from industry professionals, Health Technology Assessments are drafted after professionals carry out prioritisation exercises, and establish new pathways for the introduction of innovative medicine. All this is then discussed at Committee level and faces proper procurement before being handed over for the approval of the Minister for Health. 

Dr Vella Baldacchino also confirmed that “to date, 22 innovative medicines and 21 different cancer sites have been introduced to the Government Formulary, benefitting around 820 patients who would have otherwise been left untreated. The annual investment for such an initiative has now reached €16million per year”. 

The pricier medicines on the list include Abiraterone, which in 2020 alone cost €1.9million to cover up to 15 prostate cancer patients. It is a first-line drug that replaced Enzalutamide, which is now a second-line drug given to around 30 prostate cancer patients in 2020 alone. This cost around €3million. 

The Government has also spent around €5million to introduce Nivolumab in 2020, which was used to treat 90 patients with Melanoma and Classical Hodgkin Lymphoma among others. This is the interesting part. It is now also considered a first-line drug for non-small lung cancer, meaning more patients can be treated with it. These would have otherwise needed access to Pembrolizumab, which the Malta Community Chest Fund provides. Now, these patients can transfer to the Government’s Health Services and further relieve the MCCF. 

More treatments to be covered, including advanced melanoma

Everolimus has had a similar trajectory. With a total cost of just over €1.2million for both doses in 2020, it has been used to treat up to 47 patients with breast cancer and renal cell carcinoma. Dr Vella Baldacchino has also confirmed with TheJournal.mt

 that treatments can be extended to include neuroendocrine tumours, which until now are funded by the MCCF.

The extension of treatments is no one-off, as we can also see in the case of Bevacizumab, which in 2020 was introduced after a €1.5million investment to originally treat 35 patients. The drug covers recurrent or metastatic cervical cancer and ovarian cancer. However, in the same year of its introduction, industry professionals also decided to extend treatment to a further 21 patients who sought treatment with metastatic carcinoma of the colon or rectum, and grade 3 or 4 glioma.

TheJournal.mt can also confirm the industry might consider new indications this year for Trametinib and Dabrafenib. In 2020, both drugs treated 10 patients with advanced melanoma who are currently being cared for by the MCCF. These cost €641,000 and €500,000 respectively. 

A further six drugs were also introduced to also cover treatments for cancers such as acute myelocytic leukaemia, gastric cancer, bladder tumours, neuroendocrine tumours and locally advanced breast cancer. Everolimus, Azacitidine, Capecitabine, Cetuximab, Fulvestrant and Mitomycin C treated around 385 patients in 2020 alone and imposed a cost greater than €1.9million in just twelve months. 

The way forward now that first and second-line drugs for many clinical pathways are covered, Dr Vella Baldacchino explained, are third and higher line options which the Health Ministry is seeking. These would be “better targeted and specific to different patient cohorts”, the Health Department’s Chief Medical Officer concludes.

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