How to widen access to ground-breaking cancer treatments

Innovation in cancer care faces an awareness challenge

Covid-19 may have dominated the global health agenda over the past two years, but cancer remains as serious a challenge as ever. The disruption of health services globally is set to result in an “epidemic of cancer”, according to the World Health Organization.1 And that epidemic is likely to hit hard in 2022.

There is also good news. Innovative new cancer treatments are becoming available – particularly in the field of immuno-oncology (IO). With hundreds of clinical trials taking place, there has been exciting progress on IO therapies such as checkpoint inhibitor drugs, therapeutic vaccines, antibody treatments and T-cell transfers.

Affordability barrier

IO promises precise treatments that are likely to be less invasive and distressing for patients than today’s most common treatments: surgery, chemotherapy and radiotherapy. By taking advantage of the body’s immune system to target cancer, IO treatments are highly personalised. They can also be highly effective.

But there is a complication: cost. Research and development take huge investment, and the processes involved in delivering IO treatments are often costly too. The bespoke nature of IO means it does not have the economies of scale that other treatments benefit from, and the medical technology and specialist skills needed to monitor the impact of rounds of IO therapies are expensive.

How to sustain investment in cancer care

As new life-saving therapies become available, even the best-resourced healthcare systems need to take decisions about how to provide access. The challenge will be particularly acute in developing economies.

For patients in low- and middle-income countries (LMIC), cancer is not just a matter of sickness, but of financial risk. Faced with a serious diagnosis, many are expected to cover the cost out of pocket, which is often not feasible. This is one of the reasons why the UN Sustainable Development Goal for good health and wellbeing includes financial risk protection alongside universal health coverage.

In countries where state reimbursement of cancer healthcare costs is not an option, there could be greater emphasis on helping individuals to recognise and prepare for the likelihood of future ill-health. By spreading the potential cost of treatments, voluntary private health insurance can close gaps in provision and manage the risk of catastrophic out-of-pocket spending.

We need to talk more openly about health

Despite the benefits of health insurance, when it comes to covering the cost of future treatment there is limited take-up in many LMICs. Not only are people understandably reluctant to think about the possibility of ill-health, but those who are struggling with finances in the short term are also unlikely to want to invest in managing long-term risks.

Veronica Scotti, Chairperson of Public Sector Solutions at Swiss Re, believes that individuals are naturally uncomfortable talking about ill-health and its costs. “There is a cognitive bias around anything that is a risk to us as individuals – we tend to push it away,” she explains. “We don’t want to plan our own death. We don’t like to talk about these things.”

“There is a cognitive bias around anything that is a risk to us as individuals – we tend to push it away. We don’t want to plan our own death. We don’t like to talk about these things.”

Veronica Scotti,

Chairperson of Public Sector Solutions, Swiss Re

For people with limited legal and financial literacy, the prospect of entering a complex insurance contract may also be off-putting – even in countries where people are more familiar with insurance-based healthcare provision. “Insurance is not a product that sells itself,” says Scotti.

Financing the introduction of life-changing treatments such as IO therapies is never going to be straightforward, but it will be essential to greater health equality worldwide. Health insurance has an important role to play here – in advanced as well as developing economies – but ensuring coverage in new markets presents its own challenges, which we explore throughout this series.