Australia ‘falling behind’ on molecular testing access

Australia is falling behind the rest of the world on access to molecular testing for cancers, to the major detriment of patients, it is being warned.

The issue has been raised by Melbourne oncologist Professor John Zalcberg, who says testing has already become standard of care for certain cancers in the US and elsewhere.

By contrast, many local patients are “missing out” because they either aren’t offered, or cannot afford, comprehensive laboratory analysis of their tumours, he argues.

The head of Monash University’s cancer research program, he says the disparity was a major discussion point with overseas colleagues at the ASCO Gastrointestinal Cancers Symposium in San Fransisco last month.

“Hard not to be despondent about the very limited access to molecular testing in Australia,” Professor Zalcberg said on Twitter (link here).

“We are quickly falling behind the rest of the world and patients are missing out.”

In an interview with the limbic, he argued the main problem was Australia’s system for creating new Medicare items.

“It’s very clear that the need to understand the molecular makeup of tumours, what makes them, what drives them, and how do we interfere with their functions in order to treat them, is predicated on the ability to do testing as needed,” he said.

“But what we have in Australia is a system where most testing is linked to therapeutics.”

He said the reason for this was likely the time and expense required to apply for new MBS items through the Medical Services Advisory Committee (MSAC), which was prohibitive for many organisations except pharmaceutical companies with a new drug listing on the PBS.

“They apply to MSAC to get approval for the test as well as applying to the PBAC to get approval for their new drug. So it’s co-dependent,” he said.

“The problem is there are many drugs going through trials or that aren’t on the PBS for other reasons, but you have to know if patients might be eligible.”

“This can often be funded in a research setting, but the average patient of the average oncologist is paying hundreds or thousands of dollars from their own pockets.”

It comes amid growing calls for technologies such as comprehensive gene panels, which test eligibility for several drugs at the same time, to be funded in Australia.

While the evidence for a Medicare item may take years to develop, University of Melbourne cancer health services research head Professor Maarten IJzerman has argued funding could be made available through other means like block payments outside the MBS.

“Obviously, we should be conscious of the increasing healthcare budget and the implications of listing new cancer treatments for the sustainability of the health system,” Professor IJzerman said in an interview last year (link here).

“So rather than listing new molecular tests in the MBS on a per-test basis, Medicare could also provide a bundled payment for genetic diagnostic testing. And the rebate should then be based on the diagnostic complexity.”

Professor Zalcberg added that a starting point should be patients diagnosed with rare cancers, who often had the most limited access to appropriate testing through Medicare.

“We could start with the group of patients diagnosed with a rare cancer that can’t be cured by conventional approaches,” he said.

“These patients should have access to details and full molecular testing, which these days is about a 500 gene panel. The benefits would be enormous.”



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