Right price holds key to battle against cancer

Source:China Daily
Updated:2018-07-23 09:26:52

  Charges in the spotlight after screening of hit movie Dying to Survive

Pharmacists work at a hospital in Nanning, Guangxi Zhuang autonomous region. Prices of cancer treatment drugs in China are expected to be reduced. [Photo/Xinhua]

  For Zhi Xiuyi, a professor specializing in lung cancer at Xuanwu Hospital, Capital Medical University, in Beijing, what matters most for patients' survival is not only the effectiveness of the drugs available, but their prices.

  "Such drugs are usually very expensive, and I have seen patients having to sell their houses or farmland for treatment," said Zhi, who has worked as a surgeon for more than 30 years. "In some cases, patients from impoverished regions, such as parts of Yunnan province, may just give up treatment."

  Zhao Ping, president of the Cancer Foundation of China, and former president of the Cancer Hospital at the Chinese Academy of Medical Sciences, said that in general, antineoplastic drugs - which are used in chemotherapy to kill cancer cellsare more expensive in China than in other countries, due to many reasons, including higher customs tariffs and value added taxes.

  Lung cancer is one of the most common but deadly forms of cancer in China. It claimed 700,000 Chinese lives last year, a year-on-year increase of 26.9 percent, according to Zhi, who is also chairman of the Chinese Lung Cancer Union.

  For example, the price of Gleevec - which is commonly used to treat leukemia - in China is higher than in most other countries, and is more than twice as high as in Australia, according to media reports.

  Zhi said one of the key causes for the high prices of drugs sold at hospitals is that the various links in distributing the drugs are all profitmaking. As a result, a drug sold at a hospital could cost 10 times the original price from a pharmaceutical company.

  "The many links during the distribution of a drug, on the way from the pharmaceutical company, dealers and to the hospital, contribute most to the high prices," he said.

  Cancer drug prices have been in the spotlight with the screening of the hit movie Dying to Survive, which is based on real events highlighting the dilemma faced by a group of leukemia patients in China.

  On Thursday, media reports said Premier Li Keqiang had again urged government departments to speed up efforts to reduce the prices of antineoplastic drugs in China to answer appeals from cancer patients. This followed heated public debate after the movie was screened.

  In the movie, the patients have to rely on a smuggled generic drug from India, as they cannot afford the imported patent medication.

  Li said, "Appeals from patients with severe diseases such as cancer that they cannot afford, cannot wait, or have no access to life-saving imported drugs have highlighted the urgency to reduce the prices and ensure supply of the drugs.

  "Government departments must hurry to carry out related measures decided by the State Council executive meetings, and speed up the process if possible."

  The National Health Commission said in an interview earlier this month that a major cause for the high prices of antineoplastic drugs is the high development and research costs involved.

  Due to limited funds collected for the government's basic insurance programs, it is also difficult to meet all individual demands for such drugs from some cancer patients, resulting in heavier financial burdens for them, the commission said.

  Other factors, such as repeated diagnosis and treatment, and prolonged life of cancer patients, also contributed to increased spending by patients, the commission added.

The family of youngster Yajun, from Hanzhong, Shaanxi province, has spent 700,000 yuan ($103,000) in the six months since she was diagnosed with cancer. [ZHANG GUONING/FOR CHINA DAILY]

  Of the 138 antineoplastic drugs available in China, 66 are imported, including 27 monopoly drugs, the commission said.

  Last year, total spending on these drugs in China reached 130 billion yuan ($19 billion), it said.

  The commission said it will work with some other departments to further improve affordability and accessibility to urgently needed cancer drugs.

  Zhao, from the Cancer Foundation of China, said imported antineoplastic drugs, especially targeted drugs, are highly expensive due to the high cost of research and development.

  "A new targeted drug usually requires more than 10 years of research, and investment of more than $1 billion," he said. "Chances of success in the research and development used to be below 10 percent, and are a little more than 20 percent now."

  A pharmaceutical company has to recover all costs, including those incurred from failed trials, from a successfully developed drug and make profits before the patent period expires, which has resulted in very high prices for such drugs, he said.

  Zhu Hengpeng, a researcher in health policy at the Chinese Academy of Social Sciences, said another reason for high drug prices, including those for antineoplastic drugs, is that public hospitals tend to buy high-priced patent drugs to make higher profits, rather than cheaper generic drugs.

  Zhi at Xuanwu Hospital said some antineoplastic drugs for lung cancer are so expensive that some poor patients cannot afford the treatment even after a discount of up to two-thirds offered by pharmaceutical companies.

  "I think the government should formulate policies especially for cancer patients from impoverished regions to provide them with more financial support," he said.

  The good news is that in recent years antineoplastic drugs have become more affordable to more patients, including those from rural areas, due to extended coverage of the government's basic medical insurance programs, he added.

  "Almost all commonly used antineoplastic drugs for lung cancer in China have been included in the reimbursement list for the basic medical insurance programs since last year," he said.

  With more government efforts expected to further reduce the prices of antineoplastic drugs for lung cancermany of which are imported patent onescancer patients' financial burdens in general are expected to be further relieved, he said.

  To reduce prices of such drugs and ease the burden on patients, authorities have taken a series of measures in recent years.

One 32-year-old woman from Qingdao, Shandong province, has spent more than 1 million yuan on cancer drugs in five months. [Photo provided to China Daily]

  In May, the country lifted tariffs on all imported antineoplastic drugs, and reduced the value added tax on them significantly, a measure which could reduce prices by about 8 percent, according to some experts.

  Central government departments, including the National Health Commission, have held negotiations with pharmaceutical companies on the prices of 39 patented drugs, including 17 antineoplastic treatments, resulting in the prices of the 39 drugs being reduced by more than half on average, the commission said.

  For example, the cost of Herceptin, a drug for breast cancer patients developed by Swiss company Roche, has been reduced to 7,600 yuan per procedure after negotiations, 70 percent less than the original price, according to the commission.

  All the drugs have been included in the reimbursement list for the national medical insurance programs to ease the burden on patients, the commission said.

  Before 2016, some areas, including Zhejiang and Jiangsu provinces, had already started to negotiate prices with foreign pharmaceutical companies, which is an internationally adopted practice, and included some antineoplastic drugs for patient reimbursement.

  At a meeting held by the National Medical Security Administration on July 11, officials from the administration held talks with representatives from 10 overseas antineoplastic manufacturers and eight domestic ones over price negotiations to be held later this year.

  The administration and the enterprises reached agreement at the meeting, and the administration said it will speed up efforts so that patients can have access to antineoplastic drugs with higher quality and lower prices as soon as possible.

  Zhao, from the Cancer Foundation of China, said government negotiation is the best way and a reasonable method to reduce the price of antineoplastic drugs.

  Through price reductions, pharmaceutical companies can make their drugs reimbursable through basic medical insurance programs, which can greatly improve sales, he said.

  Li Ling, a professor of economics from Peking University, said more measures are needed to encourage domestic pharmaceutical companies to engage in research and innovation of antineoplastic drugs, which will be crucial to improving their accessibility and affordability.

  Zhi, from Xuanwu Hospital, said that with the rising incidence of cancer in China, it is crucial to accelerate research and development of new drugs in the country to offer cheaper drugs to patients.

  However, China's ability in research and development of innovative drugs still lags far behind that of some countries, such as the United States, and China will need time to catch up, he said.

  Most effective targeted drugs for lung cancer used in hospitals in China are imported, he said.

  Zhao said that in recent years private pharmaceutical companies in China have been increasingly enthusiastic in the research and development of new drugs, and breakthroughs will be made soon.

  Jiang Canwen, CEO of Sinovant Sciences, a Chinese company that researches and develops antineoplastic drugs, said although China lags behind some European countries and the US in the research and development of such drugs, Chinese companies have made remarkable progress in recent years on both innovative drugs and generic drugs.

  The company has signed an agreement with China Liver Health, a nongovernmental organization that promotes liver health, to develop innovative drugs for liver cancer, a major cancer in China.

  "I think China can make greater progress in the research and development of antineoplastic drugs over the next 10 years," Jiang said.

  "However, domestic companies face challenges such as a lack of experienced talent and stable investment. We hope to see an improved environment to encourage innovation, better policies to cultivate talent and introduce talent from overseas, and more long-term investment from the private sector."