KEY POINTS:
The Government drug-funding agency, Pharmac, made a pre-determined decision based on flawed process in denying women a 12-month course of a cancer drug, a judge was told yesterday in the High Court at Wellington.
Eight women who missed out on the funding for part or all of their breast-cancer treatment asked the High Court to reverse the decision.
They are also asking the court to quash two other key decisions by Pharmac - one rejecting funding for 12-month courses of the breast cancer drug Herceptin for early-stage breast cancer, and one approving it for a cheaper option of nine-week treatments.
"Ultimately, the real factor that comes through is only cost - that's not what Pharmac is saying, but it's effectively what has driven the decision," said Helen Cull QC, representing the eight patients.
The drug, scientifically known as trastuzumab, is for treatment of aggressive breast cancer after surgery in patients with the HER2 gene.
A one-year course has been available for end-stage patients - in whom the cancer has spread to other organs - since 2002, although those patients usually have a very short lifespan.
But Ms Cull claimed in the High Court that the July 2006 decision to reject 12-month courses for early-stage cancer was pre-determined and based on a flawed process, as was a May 2007 decision to fund the nine-week course.
Justice Warwick Gendall repeatedly probed the claims laid out by Ms Cull, insisting they be clarified.
Ms Cull claimed that Pharmac manipulated the decision-making process so that advice from its Pharmacology and Therapeutics Advisory Committee (PTAC) and a cancer treatment subcommittee, known as CaTSOP, did not effectively contradict pre-determined decisions to block the 12-month courses - which would have cost $30 million - and to enable the nine-week version.
The Pharmac board did not hear that CaTSOP made a positive recommendation on April 19, 2006, for 12-month courses, nor that PTAC agreed with the subcommittee.
Instead PTAC based its advice - against a positive recommendation - on the high cost of the drug, the cost effectiveness of the treatment, and on the likely impact on other health care.
In October 2006, the cancer subcommittee recommended Herceptin be listed for funding and said nine weeks would be reasonable if money for 12-month courses was not available.
Ms Cull said this was because Pharmac or PTAC had told it no money was available for the longer treatments - but the subcommittee should have been able to make its recommendation based on how the drug worked, not whether there was funding available.
Judge Gendall said funding would always be an issue when $30 million of health spending was at stake.
Lawyers for Pharmac are expected to respond today.
- NZPA
