Ghinea Narcyz, Little Miles, Lipworth Wendy
Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia.
J Bioeth Inq. 2017 Sep;14(3):401-410. doi: 10.1007/s11673-017-9800-2. Epub 2017 Jul 18.
Cancer is a major burden on populations and health systems internationally. The development of innovative cancer medicines is seen as a significant part of the solution. These new cancer medicines are, however, expensive, leading to limited or delayed access and disagreements among stakeholders about which medicines to fund. There is no obvious resolution to these disagreements, with stakeholders holding firmly to divergent positions. Access to cancer medicines was recently explored in Australia in a Senate Inquiry into the Availability of New, Innovative, and Specialist Cancer Drugs in Australia. We analysed the resultant Senate Report to identify competing stakeholder values. Our analysis illustrates that there are four main "goods" prioritized by different stakeholders: 1) innovation, 2) compassion, 3) equity, and 4) sustainability. We observe that, with the exception of sustainability, all of these "goods" put pressure on payers to provide access to cancer medicines more quickly and based on less rigorous evaluation processes. We then explore the consequences of giving in to such pressure and suggest that deconstructing the implicit values in calls for "enhanced access" to cancer medicines is necessary so that more nuanced solutions to the challenge of providing access to these high cost medicines can be found.
癌症是全球人口和卫生系统面临的重大负担。创新型癌症药物的研发被视为解决问题的重要组成部分。然而，这些新型癌症药物价格昂贵，导致获取受限或延迟，利益相关者在资助哪些药物方面也存在分歧。对于这些分歧，目前尚无明显的解决方案，利益相关者坚持各自不同的立场。澳大利亚参议院近期就澳大利亚新型、创新及专科癌症药物的可及性展开调查，探讨了癌症药物的获取问题。我们分析了由此产生的参议院报告，以确定相互冲突的利益相关者价值观。我们的分析表明，不同利益相关者优先考虑的有四种主要“益处”：1）创新，2）同情，3）公平，4）可持续性。我们观察到，除可持续性外，所有这些“益处”都给支付方带来压力，要求其更快地提供癌症药物获取途径，且评估过程不那么严格。然后，我们探讨了屈服于这种压力的后果，并建议有必要剖析要求“增加获取途径”获取癌症药物背后隐含的价值观，以便找到更细致入微的解决方案，应对提供这些高成本药物获取途径这一挑战。
