WHO Cancer Report Stirs Debate On Eve Of Board Meeting

As the World Health Organization Executive Board gathers tomorrow for its annual January meeting, health industry and advocacy groups have seized on a WHO report to be presented to the Board that finds high prices for cancer medicines are “impairing” governments’ ability to provide affordable treatments. One issue they may have in common is a desire for more transparency in analyses of prices.

High prices for cancer medicines are “impairing the capacity of health care systems to provide affordable, population wide access,” the report found, adding that cancer drug prices exceed those of medicines used for treating other major diseases, with costs growing at a faster rate.

The full report, “Medicines, vaccines and health products; Cancer Medicines,” and more information on the WHO website is available here [pdf]. The report will be on the agenda at the Executive Board meeting being held from 24 January to 1 February.

IP-Watch sister publication Health Policy Watch has reported on the cancer report here (HPW, WHO, 18 December 2018).

Health advocacy groups working to improve access to medicines have signalled support for this analysis in recent weeks, while a pharmaceutical industry response has been awaited.

Yesterday in an interview in his office with Intellectual Property Watch and Health Policy Watch, International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Secretary-General Thomas Cueni raised concerns about the methodology of the WHO report, as well as other reports dealing with the issue of drug pricing.

Cueni said industry is prepared for the continuing discussion on drug pricing, but views it with a “bit of apprehension” in part because the WHO technical report on cancer pricing is “deeply flawed” for failing to include consultation with industry itself.

“How can you make a report where you reach conclusions on how business decides on portfolios, where to invest, how to invest [when] there was never any consultation with the private sector?” he asked. “It was almost a precondition to be involved that you don’t have any connection with the private sector. When you look at it process-wise, it is really deeply disappointing.”

As an example, he pointed to an analysis in the WHO report of 99 cancer drugs, which he said shows the return on investment average for the 99 is $14 for $1 spent, so it is an average of 1400 percent return on R&D investment. But he noted the method for arriving at this result was unclear and not transparent.

By contrast, he said another recent report from Deloitte consulting group expressed “great concern” that the average return on investment for R&D has come down from 10 percent to 2 percent. And while he also would need to look deeper at how those numbers were reached as well, Cueni said it is more likely industry would take notice of that report which would represent a profound impact on their bottom line.

Health Advocates’ View

Meanwhile, James Love, director, Knowledge Ecology International, said of the WHO report today, “The WHO is asking good questions and providing useful and relevant data about cancer drug development. Criticism from the drug companies is expected, but when there are disputes over facts, we should have more transparency.” KEI has posted a summary of the report findings here.

Ellen ‘t Hoen, director of Medicines Law & Policy, in a blog today, noted that the WHO report follows the 2017 World Health Assembly resolution WHA70.12, which asked the WHO Secretariat:

“to prepare a comprehensive technical report to the Executive Board at its 144th session that examines pricing approaches, including transparency, and their impact on availability and affordability of medicines for the prevention and treatment of cancer, including any evidence of the benefits or unintended negative consequences, as well as incentives for for investment in research and development on cancer and innovation of these measures, as well as the relationship between inputs throughout the value chain and price setting, financing gaps for research and development on cancer, and options that might enhance the affordability and accessibility of these medicines.”

“This request should not surprise anyone,” ‘t Hoen wrote. “Governments the world over struggle with the high price of cancer medicines and the lack of appropriate treatments. They are also confronted with strong industry lobbies to ensure those prices remain high.”

She called cancer drug prices a “global crisis,” and said, “Industry will be quick to say that the high prices are needed to ensure financing for the development of new medicines.” But she noted that a “key conclusion” of the WHO analysis states:

…that the costs of R&D and production may bear little or no relationship to how pharmaceutical companies set prices of cancer medicines. Pharmaceutical companies set prices according to their commercial goals, with a focus on extracting the maximum amount that a buyer is willing to pay for a medicine. This pricing approach often makes cancer medicines unaffordable, preventing the full benefit of the medicines from being realized.

‘t Hoen directly responded to the concerns raised by Cueni about the report.

“This response … points to the urgent need for governments to act and increase collaboration to tackle the issue of high medicines pricing,” she said. “As a first step, implementing the call for greater cost and price transparency would be an important one. If pharma is worried about wrong assumptions surely they should support the call for greater transparency and disclosure of cost data.”

Cueni, meanwhile, said he has “no illusion” that the debate about pricing of pharmaceutical products will go away.

Drug pricing will be discussed at the next Fair Pricing Forum, led by the WHO and other stakeholders, which according to a source will take place in Johannesburg, South Africa on 11-13 April.

 

Image Credits: National Cancer Institute