Amanda Biggs and Dr Luke Buckmaster
This year’s health budget sees a major focus on cancer. The World Leading Cancer Care measure provides funding of $189.9 million over four years for a range of new or expanded initiatives.[1] Generally, responses from stakeholders have been positive.[2] Major initiatives are discussed below.
Funding of $55.7 million is provided to extend breast cancer screening to older women.[3] Breast cancer is the most common cancer among women in Australia, and the second most common cause of cancer-related deaths among women.[4] The government-funded BreastScreen Australia program is credited with helping reduce mortality from breast cancer among women aged 50–69 by between 21 and 28%.[5] Jointly funded with the states and territories, BreastScreen invites asymptomatic women in the target age range to a free mammography at two year intervals.[6] Women aged 40–49 years and 70 years and over can also attend, but are not actively recruited. BreastScreen reports that 56% of women in the target group participate in screening, below the goal of 70%.[7]
This initiative expands the target age range to women aged 70–74 years, as recommended by an evaluation of the BreastScreen program in 2009.[8] The evaluation pointed to a Dutch study showing a decline in mortality when breast cancer screening was extended to this age group.[9] The evaluation also noted Australia’s improvement in life expectancy and higher rates of breast cancer among older women, to support its recommendation.[10]
Screening is not without its harms. There is a risk of ‘false-positives’ (cancer incorrectly detected may prompt more invasive procedures), and ‘false-negatives’ (detection of a cancer is initially missed leading to delays in treatment) and psychological distress associated with these.[11]
BreastScreen services are delivered by the states and territories, so an expansion of the eligibility arrangements may impact on the capacity of state-based services to deliver the additional services.
The Government has also announced that it will increase the fees available to pharmacists for dispensing chemotherapy medicines by $60 per infusion ($76.37 to $136.37) for six months from 1 July 2013. The Government will also conduct a review of arrangements for funding and delivery of chemotherapy services. This measure is expected to cost $29.6 million. The review was announced on 5 May 2013 by the Minister for Health and Ageing, Tanya Plibersek, following talks between the Government and the Pharmacy Guild of Australia over funding for chemotherapy dispensing services.[12]
These talks arose in 2012 after the Government reduced by 76.2% the amount it pays for Docetaxel, a cancer treatment drug, as a result of generic versions of the drug entering the market.[13] Pharmacy groups argued that the expense of dispensing chemotherapy medicines was insufficient to cover costs.[14] They argued that the higher price paid to them for Docetaxel had effectively subsidised the cost of dispensing chemotherapy medicines.[15] A recent Senate Committee report noted that the mechanism under which the price of Docetaxel was cut was known to the Pharmacy Guild when they signed the relevant funding agreement with the Government in 2010 (the Fifth Community Pharmacy Agreement).[16] The Senate Committee recommended that the review:
… continue the examination of issues in chemotherapy drug pricing to ensure that existing funds under the Fifth Community Pharmacy Agreement as already agreed are appropriately directed to reflect the costs and benefits of the supply of chemotherapy drugs, and to ensure the ongoing supply of these drugs across all services, particularly in rural and regional areas.[17]
In other measures, $36.5 million over four years is provided to the Victorian Cytology Service to support early detection of cervical cancers and research. Funding is provided under the National Partnership Agreement on Health Services.[18] However, as this agreement is set to expire in June 2013 a new agreement will be needed to underpin this commitment.
A range of other initiatives are also funded over four years including: $23.8 million to expand the Bone Marrow Transplant Program, which provides financial assistance to cancer patients to access overseas-sourced bone marrow, stem cells, cord blood and other tissue transplants, where a local donor has not been identified ; $18.2 million to CanTeen for its Youth Cancer Networks program to support adolescents and young people with cancer; $18.5 million for a new prostate cancer research centre in Sydney, and to continue the work of two existing prostate cancer research centres in Queensland and Victoria; $19.5 million for the McGrath Foundation Breast Care Nurse initiative; $16.1 million for the National Bowel Cancer Screening Program and $8.3 million to Cancer Australia to improve cancer data collection and help support people affected by lung cancer.
[1]. Department of Health and Ageing, Budget at a glance, media release, 15 May 2013, accessed 15 May 2013.
[4]. Among women aged 34–75. BreastScreen Australia Evaluation Advisory Committee, Evaluation final report 2009, Screening monograph no. 1/2009, Commonwealth of Australia, 2009, p. 14, 17, accessed 15 May 2013.
[5]. Ibid., p. 10. Advances in management and treatment of the disease have also contributed to the decline in mortality.
[6]. Symptomatic women who do attend the program require specialised management and are generally referred to a clinical service. Ibid, p. 273.
[8]. Recommendation 2(ii). Ibid., p. 4.
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