PRICE TO PAY
Can you afford drugs that may save your life?
June 10, 2008
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Stuart Laidlaw
FAITH AND ETHICS REPORTER
When the colon cancer Angela Cordi thought she'd had cut from her body three years ago came back last year, she not only faced the prospect of energy-draining treatments again, but found herself thrust into the new face of two-tier medicine in Canada.
"I have 20 inches of colon left," Cordi says matter-of-factly.
She faces the cancer with optimism and hope. Getting the treatment she needs, however, has proved more challenging.
After a year trying several other drugs to shrink her tumours, the 50-year-old was advised by her doctor to try chemotherapy backed up by doses of Avastin every other week. Treatments began a month ago.
"The other medications just weren't working," she says, adding she finds out in July if the Avastin is helping.
Avastin is a targeted drug, says Hilary Christo, communications officer for the Colorectal Cancer Association of Canada.
Unlike chemotherapy, which attacks all fast-replicating cells (including hair and blood), Avastin focuses on tumours. It restricts the blood feeding the tumours, causing them to stop growing and even shrink.
And that, Christo says, can make the patient a candidate for life-saving surgery.
"The future of cancer treatment is these targeted therapies," she says.
But for Cordi, there's a catch.
The drug costs her $1,500 per treatment, or $3,000 a month. Cordi had to dig into her own pocket, and took out a $100,000 line of credit to pay for the medication.
On disability since her first cancer diagnosis, Cordi has no private health insurance, and the provincial health care system does not cover the treatments.
She is using her parents' modest North York home as collateral for the money she needs.
"We had a meeting at the house with the family," she says. "And we decided to do it and to take out a line of credit."
She held a fundraiser for herself Saturday night, complete with a silent auction and door prizes, in hopes of staving off using the line of credit. In the fall, she plans to hold a poker night.
She knows people who have held similar events, or maxed out their credit cards.
"That's a U.S.-style horror story," says Mike McBane, spokesman for the Canadian Healthcare Coalition.
The main criticism Canadians make of the American health-care system is that more than 40 million people do not have health insurance, McBane says, so have no access to medical treatment. Millions more are "under-insured," or trying to get by with inadequate insurance.
"Well, guess what?" says McBane. "There's a lot of people in this country who don't have access to insurance."
The coalition says about half of all Canadians do not have health insurance through their employers, so must pay for pharmaceuticals out of their own pocket, or hope their provincial health plan covers it.
Avastin, for instance, is only covered by provincial medical plans in British Columbia, Saskatchewan, Quebec, Nova Scotia and Newfoundland.
"Access depends on where you live and who you work for," says McBane.
And, warns Canadian Medical Association president Brian Day, it's only going to get worse.
For instance, he says, drug treatment with Eleprase for Hunter syndrome, a serious genetic disorder, costs about $400,000 a year, and is also not covered.
As the Canadian medical system moves away from hospital-based care, which is covered by medicare, to more out-patient treatments and home care using drug therapies, a divide is being created between those who can afford to buy the medications and those who can't.
"This is just the beginning," warns Day.
"What are we going to do when an expensive drug comes along for more common diseases?"
Still, Cordi is one of the lucky ones. She can afford to take out a loan for her health care.
Those too poor to get a loan, and with no insurance, are left without the care, McBane says. "For people in dire financial straits, their health is being put at risk."
McBane says that denying access to Avastin or other medications is a fool's savings, citing studies that show patients who are denied drug treatments end up becoming even sicker and spending more time in hospital to recover – which inevitably costs the medical system more.
As well, he says, if Canada had a national pharmacare system that covered drug treatments, the provinces would be able to negotiate deals with the biotech companies to keep costs down, as New Zealand has done.
Ontario has resisted adding Avastin to its approved list of drugs, saying its effectiveness is limited.
A spokesperson for the province's health ministry could not be reached for comment.
But in a letter to Cordi sent this past April, assistant deputy health minister Helen Stevenson acknowledged the clinical benefits of Avastin.
"However, the cost effectiveness analysis revealed that Avastin was significantly out of line with that of other effective anti-cancer agents," the letter read.
Toronto Star