Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

Abstract

Summary Background In August 2006, the Australian government announced that Herceptin (Trastuzumab) would be added to the national Pharmaceutical Benefits Scheme (PBS) of government-subsidized drugs, for treatment with adjuvant chemotherapy of HER2 breast cancer. Following initial reticence, the health minister responded to a campaign by patients and patient advocacy groups by announcing PBS subsidization which lowered the cost of a weekly dose from A$1000 to A$30. The cost to the government would be A$470 million over three years for treatment of an estimated 2100 women annually. Design We analysed the news frames used in all direct and attributed statements ( n=239) in television news coverage of the discourse preceding the Herceptin decision by the Australian government. Setting Five Sydney free-to-air channels between October 2005 and August 2006. Main outcome measures News frames or themes. Results Of five news frames identified, one (‘desperate, sick women in double jeopardy because of callous government/incompetent bureaucracy’) accounted for 54% of all reported statements. Government financial parsimony was framed as responsible for the women's plight, with drug industry pricing never mentioned. Claimed benefits of Herceptin often conflated cancer non-recurrence and survival and favoured quantification rhetoric which emphasized percentage increases in improvement rather than the more modest increases in absolute survival. Conclusions News frames invoking key tenets of the ‘rule of rescue’ dominated television discourse on Herceptin. Clinicians, patients, their families and patient advocacy groups invoking the rule of rescue can increase the likelihood of achieving their objective of gaining access to expensive healthcare such as pharmaceuticals. Rational, criteria-based public health policy will find it hard to resist the rule of rescue imperative.

Identifying stakeholder opinion regarding access to “high-cost medicines”: A systematic review of the literature

“…The public's view of the about HCM access suggests a high level of emotional involvement [27,33]. On the one hand, people may agree to the need for containing high costs of public health care spending and realise and accept the need to limit health care service utilisation.…”

“…On the one hand, people may agree to the need for containing high costs of public health care spending and realise and accept the need to limit health care service utilisation. Societal preferences do not value rarity of a certain illness with high treatment costs per se [22].On the other hand, identifying which specific patient groups can lead to an emotional demand of the public for funding of certain pharmaceuticals is also a challenge [33]. In the Australia, 68% of public respondents believe that the Government should pay for HCM [37].…”

“…It is important to note that most of the recent media commentary and ethical debate regarding funding of HCM and the analysis thereof, appears to be related to cancer therapies, and more specifically regarding Herceptin ® (Trastuzumab) [21,27,33,47,53]. The ability of some patient groups to attract attention may potentially influence the objectivity of the decisionmaking process and may lead to uneven distribution of funding.…”

“…In short, it is vital to have all stakeholders engaged before allocating medical resources [43,59]. The "rule of rescue" also influences public discourse and policy makers' decisions about fair and reasonable access to HCMs [33]. It has been shown that the individual case studies on media could have greater impact on decision-making rather than the presentation of facts and statistical data [60].…”

Healthcare Priority Setting and Rare Diseases: What Matters When Reimbursing Orphan Drugs

“…After public pressure, the county council stepped forward and contributed financially, allowing Kalle continued access to the drug. There are numerous examples of similar stories across the world (MacKenzie et al, 2008, Smit, 2015. These cases illustrate the complexity of the provision of expensive treatments for patients with rare diseases-they all involve identified, severely ill patients, there is an (apparently) effective drug, but the price of the drug far exceeds what is normally accepted by decision makers.…”