At its annual congress, the Italian Association of Medical Oncologists highlighted the perilous financial state of many public facilities providing oncology care in the country.
IHS Global Insight Perspective | |
Significance | The difficult financial state of many public healthcare facilities providing oncology care in Italy has been the focus of the annual congress of the Italian Association of Medical Oncologists (AIOM). |
Implications | In the context of the large austerity package agreed by the Italian parliament this summer and the ongoing focus on Italy's public finances in the present Eurozone crisis, it is understandable that this has been at the top of the AIOM's agenda. |
Outlook | With more effective management and stricter financial discipline, the present situation could be reversed, and it is to be hoped that this will be implemented, and that any initiatives will have time to take effect; otherwise, the consequences for all concerned, including patients and pharmaceutical companies, could resemble the situation in Greece far too closely. |
Public Oncology Care in Bad Financial Shape
At its annual congress in Bologna, the Italian Association of Medical Oncologists (AIOM) is focusing primarily on the perilous financial state of public oncology care in Italy, with the AIOM estimating that as many as 80% of facilities or departments providing oncology care in Italy are in debt, and that the reimbursement available under the oncology diagnostic groups in operation in Italy covers only 50% of the expenditure in this area, which continues to increase.
The president of the AIOM, Professor Carmel Iacono, emphasised the inefficiency of oncology care in Italy, which adds to its expense; with many Italians moving between regions in order to receive better care, costs are increased, because each patient who moves is required to re-start their treatment, incurring unnecessary extra costs. Professor Iacono told delegates at the conference that he advocates the creation of networks between the smaller hospitals and larger ones, which are better equipped in this area. Meanwhile, the AIOM's president-elect, Marco Venturini, stated that there needed to be a greater focus on dialogue between various practitioners involved in the care of cancer patients, including oncologists, pathologists and radiologists.
Another important issue that is pushing up the costs in this area is the simple fact that there are increasing numbers of patients. The AIOM estimates that currently in Italy there are 2.25 million people diagnosed with cancer, compared with about half this number in 1992. Thus, the importance of prevention is also stressed by the AIOM, in terms of lifestyle changes that can help to prevent or delay the onset of cancer.
Fewer Problems with Oncology Drugs, for Now
Interestingly, the issue of the costs generated by expensive oncology medicines is not one that is overly emphasised by the AIOM in its own press release concerning the financial difficulties of public oncology care in Italy. As pointed out by Marco Venturini, however, although at present there are no particular issues in Italy regarding stocks of oncology drugs—which is a hot topic and has become a serious issue in other countries—it is almost inevitable that this will become a problem in Italy in the future. Venturini has stated that this is almost certain to happen both in the case of high-cost biotech medicines and the older generation of medicines. On the same topic, Italian news agency ANSA cites Venturini saying there is a danger that the situation in the United States, in which older-generation—but nonetheless effective–oncology drugs such as cisplatin, doxorubicin and cyclophosphamide are becoming difficult to access because companies are no longer interested in producing them for financial reasons, could start to happen in Italy. Venturini's suggestion is that the Italian military pharmaceutical service could be involved in starting production of these substances in case such supply shortfalls should happen in the country.
He emphasised that high-cost biotech drugs represent only one-quarter of public oncology spending in Italy, and that the AIOM had been working with the Italian Medicines Agency (AIFA) for years on the monitoring system for modern, high-cost oncology drugs, which ensures that the Italian healthcare system only pays in the case of patients who benefit from the use of a drug. He contrasts this with the system in operation in England, where decisions on the reimbursement of these drugs are taken on the basis of cost-effectiveness analyses.
Outlook and Implications
It comes as no surprise that the focus of the AIOM's congress this year should be the difficult financial situation of public facilities providing oncology care in Italy, in the context of the major package of austerity measures that was passed in the summer, in which public healthcare was deeply affected. The inefficiencies of the Italian public healthcare system, particularly in relation to the fragmentation of care between regions, and the lack of proper co-ordination, is an issue with which the Italian authorities have been grappling for a long time, and there are most certainly considerable savings to be made from creating a more efficient system. This requires very effective and stringent monitoring and management, however, and these have been lacking in Italy in recent years. Perhaps the current economic turmoil in the Eurozone and Italy's acceptance of help with economic management from the IMF will help to change this situation.
In terms of high-cost oncology drugs, Italy's monitoring system—managed by AIFA—is held up widely in Europe as an example of a system that works, and succeeds in achieving its aims of keeping costs down and ensuring that only patients who benefit from treatments actually receive them. Thus, there are certainly positives in the Italian example. From the point of view of pharmaceutical companies, the poor economic state of the healthcare facilities to which their medicines are being supplied will be a source of concern, particularly in light of the recurring market panic surrounding Italy, Spain and Portugal following the severe problems being experienced by their Mediterranean neighbour Greece. Thus, the worry is that if any undue external pressure comes on Italy, the poor state of its public finances (i.e. their heavy indebtedness) could yet prove costly to pharmaceutical producers, and particularly in the oncology sphere.