Patient Access

“It’s devastating to not even be able to try a drug that could work for you… I understand a line has to be drawn but it feels unfair that other people make decisions about your life and how much it's worth.”

- Patient with breast cancer in the U.K.
“It’s incredibly cruel to use the cost-effectiveness line and it makes me shake with rage…It’s like being in a dystopian society – it has been approved in Scotland and the US and Europe but England is just lagging so far behind… It’s an abomination of human rights that the drug isn’t available. It feels like discrimination against his disability.”

- Parent of child with SMA in the U.K.
"There's no way I can't try this drug. It's the last thing that might save my life… It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication."

- Patient with breast cancer in Canada
"'If they do approve it in September, she could be too far gone and then we’d be told it’s not worth the NHS’s resources."

- Parent of child with Batten’s disease in the U.K.

What Happens in Countries Using QALYs and Cost-Based Thresholds to Determine Coverage

Other countries are often referenced as examples of how the use of QALYs or similar cost-based thresholds impact access to care:

In Australia, cancer patients are struggling to pay for immunotherapy treatments that are not covered by the government's Pharmaceutical Benefits Scheme. Click here to view the article.
In Canada, cystic fibrosis activists are petitioning their government for access to a new gene therapy drug. Click here to view the article.
Spinal muscular atrophy advocates are similarly petitioning Health Canada to expand access to treatment. Click here to view the article.
In the United Kingdom, activists fight for access to treatments for cystic fibrosis and cancer. Click here and here for articles related to cystic fibrosis. Click here and here for an article related to limited access to treatments for cancer.
The Wall Street Journal’s Editorial Board recently opined on "why the U.S. shouldn’t put the world’s most innovative drug market at the mercy of what Greece is willing to pay for a cancer treatment.” Click here to view.

In August, CVS announced that they would offer new insurance plans that exclude drugs if they exceed a subjective “cost-effectiveness” threshold.

Value assessment, and the use of cost-effectiveness in particular, is receiving renewed interest as a tool for controlling health care spending.