Aims: To assess longitudinal trends in use and cost of chemotherapy between 2000 and 2011 in Australia, and to investigate factors contributing to the trends observed.
Methods: Chemotherapy medicines were categorised using the Anatomical Therapeutic Chemical classification system. Prescription counts and costs were obtained from the Australian Statistics on Medicines publications which include government expenditure for medicines funded by the Pharmaceutical Benefits Scheme (PBS) and estimates for private and under co-payment prescriptions. Data did not include use for inpatients in public hospitals, off-label use and use in hospitals for indications not funded by the PBS, use in patient familiarisation programmes or clinical trials. Data on price changes, dates of regulatory approval and PBS funding of chemotherapy medicines were obtained from government websites.
Results: Between 2000 and 2011, there was a 165% increase in overall use of chemotherapy with the majority of prescriptions dispensed for antimetabolites, mainly methotrexate and fluorouracil. There was a 482% increase in total expenditure from AUD$ 129M in 2000 to AUD$ 752M in 2011. In 2000, the costs of ‘plant alkaloids and other natural products’ (mainly taxanes) and ‘other antineoplastic agents’ (mainly monoclonal antibodies and protein kinase inhibitors) represented 37% and 35% of the total expenditure respectively. The costs of ‘other antineoplastic agents’ increased almost ten-fold between 2000 (AUD$ 45M) and 2011 (AUD$ 497M) and represented 66% of the total expenditure in 2011. In 2011, six medicines accounted for 58% of all chemotherapy expenditure, including four new medicines (rituximab 16.5%, imatinib 13.4%, bevacizumab 8.9%, trastuzumab 5.5%) and two generic medicines (docetaxel 8.4% and paclitaxel 5.4%).
Conclusions: Price decreases of off-patent medicines and increasing use of new high cost chemotherapy medicines can explain the patterns observed. The increasing cost of chemotherapy represents a challenge for health insurers with regards to equitable and cost-effective use of cancer medicines.