Cancer patients paying for life-extending drugs are being charged tens of thousands of dollars more at some private cancer clinics, despite the price of the medicine being the same.
That’s because of variation in treatment or administration fees, charged each time a person receives a dose of their drug - which might be as often as once every three weeks.
In some cases, the difference in price between clinics can add up to more than $27,000 a year.
The discrepancy has caused some patients to regularly travel long distances to access cheaper care from Palmerston North-based oncologist Dr Richard Isaacs.
Isaacs’ patients included a Tauranga mother of two who was diagnosed with terminal, stage 4 ovarian cancer six years ago.
She responded well to drugs that were funded by Pharmac, but eventually these stopped working. There were no publicly-funded lines of defence left.
The woman, who asked not to be named, decided to fund the drug Avastin herself, and approached a private clinic in her hometown of Tauranga, run by Canopy Cancer Care.
The group has eight private oncology clinics, including in Auckland, Hawke’s Bay, Rotorua, North Shore, and Whangārei, and is owned by London-headquartered private equity investment firm Intermediate Capital Group.
She was quoted an estimated price for the Avastin drug itself of almost $27,000 for a year, if the drug was taken for that long.
In addition, the 17 doses given over that period would incur an “oncology treatment fee”, usually an estimated $2202 - or $39,880 over the 12 months.
The woman outlined the quote on the Ovarian Cancer Foundation Facebook page, and learned about Isaacs’ better prices.
She subsequently travelled from Tauranga to Palmerston North and back, every three weeks. The Avastin injection and quick consultation with Isaacs took about an hour, all up.
The drug itself costs about the same as the price quoted by Canopy. (New Zealand patients pay for a total of 3600mg, after which the drug’s maker, Roche NZ, provides the drug for free.)
However, the total of additional fees for each dose was only $751, or $12,767 over a year.
That was more than $27,000 cheaper than Canopy’s estimated treatment fees for a year.
The woman had to turn to family, friends and the wider community to help fundraise the tens of thousands of dollars needed.
That is common. Currently, NZ spends less than a third of what other countries spend on medicines, after accounting for population size and GDP.
This strangles the supply of new drugs that are standard care in comparable countries and forces people to try to find money to have medicines administered privately.
Finding the money was difficult in today’s economic environment and with many others needing help, the woman said, and every dollar mattered in the fight for more time.
She wanted to highlight the treatment fee price differences, “to make it a little bit easier for anyone that comes after me with this disease.”
“My hope is that cancer patients might end up with access to the drugs they need without travelling long distances when ill, and the public will have a knowledge of what is happening.”
Canopy Cancer Care: ‘Costs can vary for several reasons’
Canopy’s quote explained that it doesn’t add a margin to the price of any medication, and its oncology treatment fee “includes your nursing care, ward consumables, medical supervision during treatment, patient results monitoring with 24/7 phone access to an on-call specialist, Monday to Friday 8am to 6pm access to an on-site nurse between cycles.”
The group employs more than 30 doctors and 100 staff, and treats upwards of 3000 patients a year.
Phillipa Green, general manager of Canopy Cancer Care, said its world-class facilities and internationally-renowned specialists provided patients with choice, and “a more personalised approach to care delivery, access to advanced treatments and additional diagnostic tests”.
Canopy is the only private oncology provider that proactively takes part in an external accreditation process, she said.
“Costs of private care can vary for several reasons. The overall offering will impact the cost set by the different providers. As a private provider, very importantly, all our pricing contracts are discussed and agreed with major insurers, including Southern Cross,” Green said.
“This pricing structure can be location-dependent and in some areas the pricing is lower than the major cities for example. Simply, in regional areas, like Palmerston North, fees can be lower than in other areas.
“At the current time with the significant and widening gaps in the health workforce across New Zealand, Canopy Cancer Care has invested in a sizeable workforce to ensure we can manage demand and remain operational during unexpected situations ensuring that patient care is not disrupted. This investment ensures that we have the right people in the right roles trained to deliver exceptional care – and again, this is monitored by an external accreditation agency.”
Price difference ‘outrageous’: South Island patient
Another woman with ovarian cancer travelled every three weeks from her South Island home to receive Avastin at Isaacs’ Palmerston North clinic.
The 54-year-old, who asked not to be named, was diagnosed after symptoms including needing to urinate frequently.
Her GP felt a tumour and sent her for a scan that showed the disease was stage 3. The public health system worked fast and well, she said, and she had chemotherapy and surgery quickly.
“With ovarian cancer, [medical staff] often tell you - ‘It’s treatable, but not curable.’ So most people start doing a lot of research to see what’s going to help them live longer. Much difference is good difference.
“I joined a bunch of Facebook groups and could see that in Australia women with the same diagnosis as me would often have Avastin as part of their treatment programmes. It’s fully funded there, but not in New Zealand.”
Her “fantastic” public oncologist supported Avastin being added to her treatment. She got three quotes. The estimated fees per injection varied, she said - $2438 at the Bowen Icon Cancer Centre in Wellington ($41,446 a year, if the drug was taken for that long), about $1900 at a local clinic ($32,300 a year), and $751 ($12,767 a year) at Isaacs’ clinic.
It was worth going to and from Palmerston North every three weeks, even after factoring in flights to Wellington, where she stayed with friends or family, and the rental of a car to travel from there. Sometimes a friend would drive her.
The mother of two said, in her opinion, the price difference between clinics was “outrageous” and exploitative of people at their most desperate.
Both the women who spoke to the Herald about funding Avastin are no longer receiving the drug, for different medical reasons.
A spokeswoman for the Bowen Icon Cancer Centre, which is part-owned by an international private equity firm, told the Herald that it treats the broadest range of cancers, from early to late-stage, and covering all treatment types such as chemotherapy, immunotherapy, hormone therapy and radiation therapy.
“Patients have access to specialist-trained cancer nurses, a network of oncologists, radiation therapists, pharmacists, and compounding pharmacy services under one roof, alongside wraparound supportive care services focused on managing side effects. This integrated approach allows us to offer personalised, seamless care throughout their entire treatment journey.
“As a private day hospital, Icon’s pricing aligns with other comprehensive cancer care providers and what is approved in our private health fund agreements. This pricing is only applicable to patients who do not have private health insurance and choose to self-pay in order to be treated in a private hospital setting.”
When patients decide which clinic to use they often consider factors including location and travel distance, whether they have private health insurance, the type of treatment needed and complexity of their cancer, and personal circumstances, the spokeswoman said.
“It is therefore not unusual for patients to consult multiple cancer treatment providers and we support a system that provides options for patients.”
Isaacs declined to comment on the difference in prices or the approach of other clinics. He told the Herald he has worked independently since establishing his practice in 1998, and tries to set fair and reasonable assessment and administration prices, without reference to other centres.
In 2009 he was made a Member of the New Zealand Order of Merit, for services to oncology. He has a history of advocacy on medicine access, including being a leading voice urging public funding of a 12-month course of Herceptin for women with early-stage breast cancer, which happened in December 2008.
Before that breakthrough, a number of women with breast cancer travelled long distances to receive Herceptin from Isaacs in Palmerston North, after finding his treatment fees were tens of thousands of dollars lower than elsewhere.
Ovarian Cancer Foundation: Bigger problem is Pharmac funding
Jane Ludemann, founder of the Ovarian Cancer Foundation NZ, said it was “aware there can be a significant difference in the cost of unfunded treatments”.
However, she said if bevacizumab (Avastin) was funded by Pharmac it would be administered for free at local hospitals.
“The original application for bevacizumab was made to Pharmac in 2013 and they’ve tried to decline it twice in the past three years. It’s been funded in Australia for ovarian cancer since 2014.
“The human cost to women and their families and inequities caused by gaps in public funding for cancer treatments is immense.”
Public funding of medicines is in the spotlight after the Government failed in last week’s Budget to fund 13 new cancer drugs, which it had promised to do during the election campaign.
Pharmac’s budget will increase by more than $1.7 billion over four years, but that money is needed to ensure it can keep funding the drugs and therapies it already covers.
Finance Minister Nicola Willis said she regretted not being able to honour the pre-election promise, while Health Minister Dr Shane Reti blamed a “fiscal cliff” left by the previous Government, saying, “we have prioritised this essential investment and anticipate that future Budgets will help widen medicine access, including to cancer treatments.”
National’s pre-election manifesto said funding the 13 new cancer drugs - covering lung, liver, bowel, kidney, bladder, head and neck and skin cancers - would cost $280m in ring-fenced funding over four years.
On Tuesday Prime Minister Christopher Luxon said the Government was aiming to make an announcement on funding cancer drugs “very shortly”. Improving cancer treatments was a “top five goal” for the coalition Government, he said.
Sixteen New Zealand cancer charities have published an open letter to the Prime Minister and other ministers, saying they and cancer patients were left in disbelief by the lack of funding allocated in Budget 2024, and the delay would cost lives.
Pharmac puts medicines it wants to fund but does not have the money for on its “options for investment” list, which is confidentially ranked. There are about 140 drugs or therapies on the list, some of which have been listed for years.
A series of Herald articles this year have highlighted the lack of funded medications for people with multiple myeloma, which is a common blood cancer. One retired GP sold his family home to fund his medicine. The family of another patient, Simon Clark, collects aluminium cans to sell as scrap to help fundraise.
Nicholas Jones is an investigative reporter at the Herald. He was a finalist for Reporter of the Year at the 2024 Voyager Media Awards, and has won numerous national media awards for his reporting and feature writing.
