LISBON, PORTUGAL—New and better drugs to treat diseases such as advanced breast cancer will have little effect on improving patient outcomes if a country does not have good health care structures in place, Professor Richard Sullivan, MD, PhD, told attendees at the Advanced Breast Cancer Third International Consensus Conference.

Without good systems, Sullivan, of the Institute of Cancer Policy, King’s Health Partners Comprehensive Cancer Centre, King’s College London, United Kingdom, said there was little point in even discussing whether breast cancer drugs were affordable or not.

“As things stand, I think many of the new molecular targeted agents are not affordable to many European countries, and this is only going to get worse,” said Sullivan.

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However, in a second presentation, David Taylor, MD, Emeritus Professor of Pharmaceutical and Public Health Policy at the University College London School of Pharmacy, United Kingdom, told the conference that although individual drugs can appear to be expensive, their cost is offset by many other drugs becoming cheaper over time as their patent protection expires and, overall, the spending on drugs at national and global levels remains stable. Although, in richer countries, the spending on medicines has grown in absolute terms, it has remained stable as a proportion of gross domestic product (GDP).

“If we want to afford better medicines for women with advanced breast cancer, we can do that,” Taylor told the conference. “Of course, new treatments can be expensive for individual budget holders, … but, given that we are now close to developing definitive treatments for many cancers, I have no doubt that it is right for richer countries to continue investing through purchasing innovative therapies. One of the unique advantages of medicines is that, although they appear expensive when first introduced, their cost falls to lower levels after the patents that are needed to encourage and fund further research expire. This is not normally true of any form of health or social care that has high labor costs.”

Sullivan believes that the discussion about improving health care structures, particularly in regard to surgery and radiotherapy, has to come before one about the affordability of individual drugs.

“Talking about medicines makes sense if you are a patient accessing a safe, well-regulated, well-governanced, well-provisioned work force; then you can have the argument about the costs of medicines,” Sullivan told the conference. “But if you are a patient in a country where the health care system is unregulated, chaotic, with no transparency and no way of looking at outcomes, then this becomes an irrelevant argument. If you haven’t got a good health care system with firm foundations, then no amount of new medicines or new interventions will improve patient outcomes.”

Sullivan said a certain level of investment in health care was important, but after that what really mattered was how the money was used. “There are countries like Romania that have had no improvement in their outcomes for breast cancer over the last decade, but they are putting no money into the system. Then you get the other situation where a country is putting money into the system and a reasonable amount of money into its breast cancer care system, but there doesn’t seem to be a correlation with outcomes, and this is because you have got to connect the money to structural reform. So you get this ridiculous situation where Greece is now spending the biggest amount in Europe, but it has made no structural reforms, and you see little improvement in their breast cancer outcomes.”

Sullivan said breast cancer treatment and outcomes could be used as indicators of the health and strength of a country’s cancer care system generally. “From a health care system and global perspective, increasingly breast cancer acts as a bell-weather disease. It’s an indicator of how well health care providers adhere to treatment guidelines and audit their outcomes, the availability of general and specific care, radiotherapy and medicines.”