2024-05-03 11:32:45
Innovative target therapy drugs can help a woman, but they are not reimbursed in Lithuania.
The dose she needs for a month costs more than 5,000 euros, which is unaffordable for a mother with three young children. With the help of the Cancer Treatment Support Fund, thanks to donations from people of good will, Vilija can be treated with these drugs for the time being.
“I have no right to give up, I must overcome the disease or at least stabilize it so that I can raise my children as much as possible,” said Vilija with a determined attitude.
Flowers for mom or on mom’s grave?
There are dozens of such women in Lithuania. The thought of what could happen in a few months, a year, is as far away as possible. The reason is that their treatment options have already been exhausted. More precisely, innovative medicines, which are not yet reimbursed in Lithuania, would help them to live a quality life for a few more years, maybe even a decade. Women are already successfully treated with these drugs in practically all European countries, but they are not available in our country.
Breast cancer is one of the most common oncological diseases in women, about 1,600 women are diagnosed with it every year. In most cases, they are successfully treated, recover and the disease becomes a thing of the past, but about a quarter of them are diagnosed with widespread disease. The 5-year survival rate of women with metastatic breast cancer in Lithuania is only 29%. – this is one of the worst indicators in Europe.
The reason is that innovative drugs that can significantly improve this indicator are not available. Those who can give sick women as many days of life as possible, and their children – the opportunity to rush to welcome them home on Mother’s Day next year, instead of bringing flowers to their mother’s grave.
The challenge for the doctor is to tell the patient that there is treatment, but it is not available in Lithuania
“The problem? This is too mild a description of the situation, when you know that the patient has treatment, but in Lithuania these drugs are not reimbursed. It’s very difficult, because one moment you give a person hope, and the next you take it away,” admits Aleksandras Petrauskas, oncologist and chemotherapist at Vilnius University Hospital’s Santaras Clinic.
According to the interviewee, such situations still occur in his practice when it comes to new, innovative, effective and expensive drugs.
“I tell my patients what the situation is. Most of them, after hearing the price, give up, because they understand that the treatment can last not a month or two, and cost tens, hundreds of thousands of euros. If I see that the patient is interested, we try to find help through support programs. But it is not right when innovative drugs for the treatment of metastatic breast cancer are reimbursed in many European countries, even Bulgaria, Romania, Poland, but, unfortunately, not in Lithuania,” the interviewer states, admitting that such a situation demotivates the doctor as well, forces him to feel inferior, powerless.
And, on the contrary, he can provide more than one example where a woman with an advanced disease was lucky enough to receive effective treatment, and her situation changed dramatically.
“I have a case where, after a year of treatment, the patient’s metastases in the liver have decreased to such an extent that it is possible to start thinking about surgical treatment, thus further delaying the progression of the disease. This greatly motivates the doctor to look for other possibilities, besides, medicine is advancing rapidly, new tools are emerging, and you can see that the patient lives for a decade instead of a few months or years”, A. Petrauskas recalled hopeful examples.
Treated with innovative drugs, such patients live a full life, often work, pay taxes, so even if evaluated only from the economic point of view, such treatment is effective.
Lucky Lottery Ticket – Medicine received through the Accessibility Program
Vilija Stankevičienė from Vilkaviški could be an example of such a successful treatment. In 2019, she was diagnosed with stage four breast cancer, the cancer is aggressive – HER2 positive, difficult to overcome. Three years of treatment did not give good results. When the hopes of controlling the disease were already very few, Vilija received the encouraging news – through the accessibility program, she was able to obtain drugs for the treatment of widespread HER2-positive cancer, which have not yet been reimbursed in Lithuania. In September 2022, Vilija received the first dose of medication.
The tests carried out in 2023 surprised both the doctors and Vilia – there was no tumor, only a couple of foci remained. Her treatment continues, every three weeks she goes to Kaunas to receive these medicines.
“I have already received 24 doses of these drugs. I continue to live, I feel good, I’m going,” Vilija is happy.
Having drawn a lucky lottery ticket herself, she now helps her brothers and sisters of fate – she volunteers at the oncology patients’ association.
“It’s just a very, very unfortunate thing that our healthcare system is such that not everyone has access to those medicines. How many women could be saved. I even cry sometimes when I think about it”, regrets the interviewer.
Medicines take a long time to reach the patient
Vilija, as a living proof of the effectiveness of innovative treatment, participated in the discussion “Why is reimbursement of vital drugs for women with breast cancer delayed in Lithuania?” organized by the Ministry of Health of the Republic of Lithuania in January of this year.
“To our knowledge, currently nine applications have been submitted for health technology assessment in Lithuania regarding the reimbursement of the latest drugs intended for the treatment of metastatic breast cancer, three more for early-stage breast cancer. As some of them have been waiting for their turn since 2021, it means that until now these innovative medicines do not reach patients. Unfortunately, we did not hear a positive answer as to when these drugs will be available to sick women, neither during this discussion nor after it,” said Sigita Šeštokaitė-Puvačiauskienė, president of the association Onkologija.lt.
It is difficult for many patients to understand why the drug’s path to them is so long and winding, lasting years. The decision on the reimbursement of the drug in Lithuania should be made in a little more than half a year, it takes another 6-12 months until the drug is on the reserve list and funds are found to compensate it. So, in total, the process of compensating the drug should take about a year, but in reality it can last two, three or more years… We are faced with the situation that in other countries of the European Union, the drug is already compensated, and in Lithuania this possibility has not even started to be considered. The situation is especially unjustified when we talk about patients with oncological disease and new drugs that are recommended in European guidelines as effective and have evidence.
Medicines can wait, but patients with metastatic breast cancer, unfortunately, cannot. Their chances of surviving until next Mother’s Day decrease rapidly as the disease progresses.
The problem is not lack of money, but proper planning of the health budget
Speaking on this topic in the aforementioned discussion at the Ministry of Health, its participants heard the traditional answer – there is a lack of funds to compensate for the latest medicines.
“Actually, according to the funds allocated per person in the health care sector, we are ahead of Latvia, Estonia and Poland. What’s more, this year’s Mandatory Health Insurance Fund budget is almost 3.5 billion. EUR, which is 13 percent. more than last year. We doubt that the problem is a lack of funds. Especially since there may only be about 100 women with metastatic breast cancer in Lithuania, it would not be a million-dollar investment,” Aurelija Juškevičienė, director of the Cancer Treatment Support Fund, is convinced.
According to her, seeing such numbers and knowing the situation, reasonable doubts arise as to whether this is a matter of lack of funds or proper budget planning and priorities.
“As of today, SAM has not committed anywhere and has not even specified how much health funds it plans to allocate to the inclusion of new drugs in the reimbursement system. Even if there were sufficient funds in the budget, such a situation would in no way ensure sustainable, transparent and, above all, budget planning focused on the most effective treatment.
We believe that rational planning of the need for the latest and most effective drugs is necessary, and at the same time, a measure that requires few financial and human resources, which can improve the availability of missing drugs in general, and especially for the treatment of metastatic breast cancer, in Lithuania,” says the interviewee.
We invite everyone who is indifferent to this situation to sign the petition prepared by the association Onkologija.lt, by which we ask to ensure ALL women with breast cancer the most suitable effective treatment as soon as possible. So that they can celebrate Mother’s Day with their children next year as well.
All by June 1. the collected signatures will be handed over to the Minister of Health Arūnas Dulkis.
2024-05-03 11:32:45