In the last twenty years, "target therapies" have revolutionized the panorama of anticancer treatments. But the price has been high and is destined to rise further. Dizzyingly. Seriously endangering equal access to medicines and the sustainability of health services.
The European Observatory on health systems dedicates a crucial chapter of its latest report to the future of treatments. Highlighting all the unknowns on the table, starting with the costs. In 2007, the global cost of anticancer drugs was estimated at $31 billion, $18 billion of which was spent in the United States alone, which accounts for just 4.8% of the population. By 2027, the global cancer treatment market could reach $300 billion. Compared to today, however, the supply scenario is destined to change. The two sectors on which there are bets – that of small molecules and monoclonal antibodies – will be enriched with new products: 37 are already close to being approved by the Food and Drug Administration and the EMEA; about 500 are in patient trials, 300 of which inhibit specific molecular targets. This number will grow impressively: by 2010 there will be almost 5,000 molecules ready for trials. At the same time, the costs incurred by pharmaceutical companies will increase. Ten years ago the average cost to develop a new anti-cancer molecule was around 400 million dollars, today it is one billion. At this rate, 2 billion will soon be reached. "There is a risk - writes Karol Sikora, professor of Oncology at the Imperial College School of Medicine at Hammersmith Hospital in London and author of the chapter on drugs - that industries will stop developing anticancer drugs, preferring therapeutic areas marked by lower individual variations and therefore more profitable. However, there is another immediate danger: the rationing of access to innovative medicines. Which inevitably means inequality. A study conducted in 2007 clearly demonstrates the differences within the EU: on average, Europe spends 16 euros per person on anticancer drugs, but it ranges from 9 in Poland to 22 in France. In any case, we are far from the average 38 euros spent in the States. Increasingly, access to care will be determined by cost and political will. In 2007, a cancer patient spent about 36,000 euros on treatment in Great Britain. This figure could rise to 147,000 euros by 2027, taking into account the progressive transformation of cancer into a chronic disease. A debacle for health budgets. “The spending could lead to an increase in taxation up to 60% in the UK,” comments Sikora. And often you may be forced to choose between medications and non-pharmacological care. The report does not provide "turnkey" solutions, but invites governments and health authorities to act immediately. Planning cancer care like pensions. Involving patients and associations in the debate. And by monitoring the effective effectiveness of the new molecules gradually introduced on the market. The future of cancer will arise from the interaction between four factors: the success of new technologies, the social will to pay, the development of the assistance offer and the financial mechanisms that support it. Il Sole 24 Ore Sanita' of 19/02/2008 N. 7 19-25 FEBRUARY 2008 p. 13
