How does the operation of PHARMAC's 'Community Exceptional ...

eligible people in New Zealand and the availability and suitability of existing
medicines, therapeutic medical devices and related products.
The subcommittee considered that the government’s priorities for health funding
were either neutral or against a positive recommendation. Members also noted
that $30 million per year could be better spent on other areas of cancer control
if such funding were available. One member noted that given the extent of the
funding required, consideration may need to be given as to whether the funding
would be better directed towards other non-cancer health services (Paragraph
56 Walsh v. PHARMAC BC200860616).
The Use of Cost-utility Analysis
The decision as to whether to fund Herceptin was also referred by the
PHARMAC Board to the PTAC committee. This committee was asked for its
advice as to the reasonableness of the cost-utility analysis (CUA) provided by
PHARMAC staff. A CUA provided in the manufacturer’s application (Roche
Corporation USA) was also considered by PTAC. The committee advised the
PHARMAC Board that there was doubt about the optimal duration and timing of
Herceptin treatment. They also stated that there was a high budgetary impact
which would have significant consequences for future funding of other
pharmaceuticals and could also negatively impact on the availability of
cardiology services for non-breast cancer patients.
The committee’s recommendation to the Board, based on the interim trials
published to date, was that Herceptin may have a role to play in the treatment of
primary breast cancer. However, PTAC considered that with the data provided,
they were unable to determine the optimum schedule and duration of treatment,
the magnitude of treatment or the benefit on the overall survival. Therefore,
PTAC could not calculate the cost-effectiveness of Herceptin.
The committee considered that given the high cost of Herceptin, the early
nature of the clinical trial data, and a significant impact on other services and
investments in health care, which may offer better health outcomes for the
money invested, they did not consider it appropriate to make a recommendation
for funding this product at this time. It noted that although there was insufficient
evidence to make a positive recommendation for funding the product “at this
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