Better Health Outcomes for New Zealanders

Epidemiology, Survival

Rates and Access to

Medicines

Cancer in

New Zealand

The growth in year-on-year

healthcare investment is up to 29

times higher than for medicines

0

5

10

15

20

25

30

35

2011 2012 2013 2014 2015

DH

B:P

HA

RM

AC

inve

stm

en

t d

iffe

ren

ce

Year

DHB:PHARMAC investment difference

Why the

discrepancy?

Source: PHARMAC and New Zealand Treasury Vote Health Report

Cancer in New Zealand

New Zealand invests well below the

OECD average on medicines

In 2014 New

Zealand

invested only

9% of the total

health budget

compared to the

OECD average

16%

Source: OECD (2015), Pharmaceutical spending (indicator). doi: 10.1787/998febf6-en

Vote Health 2014/15 THE ESTIMATES OF APPROPRIATIONS 2014/15 - HEALTH SECTOR B.5 Vol.6

Cancer in New Zealand

0

5

10

15

20

25

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Medic

ine investm

ent

as a

perc

enta

ge o

f th

e

tota

l health b

udget

Year

Medicine investment as a percentage of the total health budget

Australia Canada Japan New Zealand UK US

New Zealand’s medicines

investment per person is decreasing

New Zealand

invested 15% less

per person on

funded medicines in

2013 than in 2000

1. In 2013 dollars. Excluding ~NZD 45M on vaccines for 2013 onwards 2. Excluding inflation (CAGR: 2.5%), indexed to 2013

Source: PHARMAC Annual Reviews; Statistics New Zealand

Cancer in New Zealand

185 179 167 163 165 168

160 164 166 164 169 164 177

158

0

50

100

150

200

250

Year

-1.2% p.a.

CAGR

Overall, 2000 – 2013:

-15% per capita

$714 m1 budget

3.86m popn

$733 m1 budget

4.63m popn

PH

AR

MA

C r

ea

l in

ve

stm

en

t p

er

ca

pita

(N

ZD

; re

al te

rms in

de

x t

o 2

01

3)

2000 2005 2010 2013

New Zealand’s average cancer rates

are over 62% higher than the world

average

0 50 100 150 200 250 300 350

ASR (W) rate per 100,000All

cancers

exlc

. non-m

ela

nom

a s

kin

cancer

2012 all cancers excluding non-melanoma skin cancer rates

World Average United Kingdom Australia New Zealand

• Highest incidence rate of melanoma

• 4th highest rate of colorectal cancer in women

• 9th highest rate of colorectal cancer

• 13th highest rate of all cancers

• 18th highest rate of prostate cancer

• 19th highest rate of breast cancer

Source: GLOBOCAN 2012 (IARC)

PHARMAC Pharmaceutical Schedule 2015

Cancer in New Zealand

New Zealand has:

New Zealand’s mortality rate

exceeds Australia’s average by 8%

0 20 40 60 80 100 120

ASR (W) rate per 100,000

All

cancers

exlc

. non-m

ela

nom

a s

kin

cancer

mort

alit

ies

2012 all cancers excluding non-melanoma skin cancer mortality rates

World Average United Kingdom Australia New Zealand

• Colorectal mortality rates are almost double the world average

• Melanoma mortality rates are more than four times the world average

• New Zealand mortality

rates exceed the overall

world average

Presentation name

While survival is improving, New

Zealand’s survival rates are less

than Australia and US

75

76 76

77 77

78 78

1998-1999 2000-2001 2002-2003 2004-2005 2006-2007 2008-2009 2010-2011

One-year relative survival %

• Australia’s one-year

relative survival rate is

4.5% higher than New

Zealand

• Australia’s five-year relative survival rate is 4% higher than New Zealand

• US’ five-year survival rate is 5.6% higher than New Zealand

Source: Ministry of Health. 2015. Cancer patient survival 1994–2011. Wellington: Ministry of Health.

Aye et al, NZMJ, 2014

US Cancer Society, Facts and Figures, 2014

Cancer in New Zealand

57.7

60 60.461.1 61

6263.3

1998-1999 2000-2001 2002-2003 2004-2005 2006-2007 2008-2009 2010-2011

Five-year relative survival %

Compared to Australia, New Zealand

has much higher rates of avoidable

cancer deaths

0

10

20

30

40

50

60

70

80

90

100

Bowel Breast Lung Non-HodgkinLymphoma

Prostate Stomach Melanoma

Perc

enta

ge o

f avoid

able

death

s

Cancer type

Avoidable cancer deaths compared to Australia

Māori Non-Māori Australia

Avoidable deaths are

particularly high for Māori

“The avoidable deaths in NZ may reflect a combination of earlier diagnosis, faster access to treatment and more effective therapy in Australia”*

Graph depicts the percentage of avoidable cancer deaths using Australia as the baseline.

Distribution of avoidable deaths by tumour site and ethnicity

Source: Sanford et al, How Many Cancer Deaths could New Zealand Avoid if Five-Year Relative Survival Ratios were the same as in Australia? Australian and New Zealand Journal of Public Health, 2015*

Cancer in New Zealand

Out of 13 countries, New Zealand has the lowest ranking

for access to cancer medicines

Canada Switzerland Australia UK Germany Norway Sweden New Zealand

2009 2013 2009 2013 2009 2013 2009 2013 2009 2013 2009 2013 2009 2013 2009 2013

12 9 6 2 10 12 11 7 4 3 9 4 7 6 13 13

11 10 2 7 9 9 8 12 6 5 12 11 10 8 13 13

10 10 5 11 12 6 9 4 4 9 11 13 8 5 13 8

10 12 9 13 11 11 5 9 3 8 8 4 7 3 13 6

Comparison of cancer medicines access for 13 countries – 2008/09 and 2012/13 ranked 6 to 13

Source: Office of Health Economics, Richards Report 2014

Cancer in New Zealand

Access to medicines

post-diagnosis

Cancer <5 years

Cancer 6-10 years

Cancer >10 years

Cancer hormones

New Zealand only funds 14% of

highly effective available medicines

for the 8 most prevalent cancer

types

05

101520253035

Num

ber

of m

edic

ines

Cancer type

Number of cancer specific medicines vs medicines funded in NZ

Number of available medicines Number of funded medicines in New Zealand

In some cases NO cancer

specific medicines are

funded in New Zealand

Data is not inclusive of chemotherapy and radiotherapy treatment

Source: GoodRx Inc 2015, PHARMAC

Cancer in New Zealand

Better Health Outcomes for New Zealanders

Research and

Cancer Costs

It takes an average of 12 years to develop a medicine.

Only 12% of drugs entering clinical trials result in

approved medicines

Source: Shahza Somerville, Jessica Holden Kloda, Applied Clinical Trials, 2015

Cancer in New Zealand

It now costs an average $3.8 billion to develop a

medicine

Source: 2010 Scientific American

DiMasi JA, Grabowski, HG. The cost of biopharmaceutical R&D: is biotech different? Manage Decis Econ. 2007;28:469-479

Cancer in New Zealand

$201 million

$464 million

$802 million

$1.2 billion

$3.8 billion

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

1975 1987 2001 2006 2015

De

velo

pm

en

t co

st 1

,00

0s

Year

Development cost of an average drug over time

New Zealand lags behind the OECD

average for reimbursing innovative

medicines by almost a year.

4 Medsafe

approved

cancer specific

medicines have

been waiting for

funding for up

to 4 years

Average time from registration to reimbursement (days) for new medicines, 2009-2014

Source: IMS COMPARE Report 2015

Cancer in New Zealand

88100

118 118

172 180200 204

245

327

355381 383

417434

507533

575 579

633

0

100

200

300

400

500

600

700

JPN GER AUT GBR SUI USA NED NOR SWE FIN IRL FRA AUS BEL ESP ITA POR CAN NZL NOR

Nu

mb

er

of d

ays

Countries

Average time from registration to reimbursement (days) for new medicines, 2009-2014

Average 322 days

New Zealand ranks last out of 20 comparable OECD

countries for access to innovative medicines

Source: IMS COMPARE Report 2015

Cancer in New Zealand

0

10

20

30

40

50

60

70

80

90

100

Perc

enta

ge o

f re

imburs

es a

ccess to n

ew

regis

tere

d m

edic

ines

Country

Percentage of reimbursed access to new registered medicines

Average 54%

There are over 800 innovative medicines in clinical

testing for cancers

Source: American Cancer Society 2015

Cancer in New Zealand

2358

8235

2184

30106

35123

9238

514950

1753

22729

5627

0 50 100 150 200 250

Bladder

Brain

Breast

Colorectal

Head & Neck

Hematological Maglignacncies

Kidney

Leukemia

Liver

Lung

Lymphoma

Multiple Myeloma

Ovarian

Pancreatic

Prostate

Sarcoma

Skin

Solid Tumors

Stomach

Other

Unspecified

Number of medicines in development for cancers

Ca

nce

r ty

pe

Medicines in development for cancers

As an example, innovative medicines have

decreased the level of deaths from cancer by 22%

in the USA since the 1990s

23 MILLION

Years of life saved due to

cancer treatment

advances, 1988 - 2000

$1.9 TRILLION

Value of improved cancer

treatment to society based

on improved productivity,

extended life and other

factors, 1988-2000

Better access

Source: DN Lakdawala, et al. “An economic evaluation of the war on cancer” Journal of Health Economics 2015

National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015

Cancer in New Zealand

to innovative medicines will

have a positive effect in

New Zealand

Better Health Outcomes for New Zealanders

Cancer in New

Zealand

Medicines New Zealand is the industry association representing

companies engaged in the research, development, manufacture and

marketing of prescription medicines.