Julie Owens (Parramatta, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That the House:

(1)

notes:

(a)

that Australia has the highest reported rate of mesothelioma in the world;

(b)

that there has been a four to five-fold increase in the rate of mesothelioma since the early 1980s and that it is estimated that this rate will continue to increase for the next five to 10 years;

(c)

the chemotherapy agent Alimta is the only treatment registered for use in mesothelioma, and in combination with Cisplatin, represents the ‘gold standard’ for mesothelioma treatment in Australia;

(d)

treatment by Alimta can significantly increase a patient’s survival time as well as improve a patient’s quality of life in its final stages;

(e)

Alimta is listed on the Pharmaceutical Benefits Scheme (PBS) for persons who have contracted lung cancer for smoking, but is not approved for patients with mesothelioma;

(f)

access to Alimta for mesothelioma patients is currently inequitable across Australia, with some States and companies providing various schemes to compensate victims of asbestos exposure and some patients having to pay for Alimta privately at great expense; and

(g)

the UK National Institute for Health and Clinical Excellence recently approved the use of Alimta in the treatment of mesothelioma sufferers and the governments of France, Sweden and Japan subsidise the drug for sufferers in those countries; and

(2)

calls on the Government to take all necessary action to support the inclusion of Alimta on the PBS for the treatment of all mesothelioma sufferers.

It was with great sadness that I visited local hero and anti-asbestos campaigner Bernie Banton a few weeks ago at Concord hospital. Bernie had just been diagnosed with mesothelioma, the most debilitating and aggressive of asbestos related diseases. Bernie Banton is well known as the anti-asbestos campaigner who worked tirelessly to hold the corporate giant James Hardie accountable to thousands of asbestos sufferers nationwide. His epic struggle helped lead to the establishment of a $4 billion compensation fund and brought some financial security to asbestos victims and their families.

Bernie then moved on to fight for the establishment of an asbestos diseases centre at Concord hospital—a centre now established and treating Bernie. At the time he was diagnosed with mesothelioma, Bernie had already been campaigning for some time to have the drug Alimta listed on the Pharmaceutical Benefits Scheme for all mesothelioma victims, even though he himself would have been eligible to be treated with Alimta and will be so treated now. But many Australians who contract the disease will not be eligible, and it was for an end to the lottery for mesothelioma sufferers that Bernie was campaigning—a lottery in which the quality of your treatment is determined by where you live, how you contracted the disease and your capacity to pay.

Mesothelioma is the worst of the asbestos diseases, a fatal and aggressive cancer that attacks the lining of the lungs, heart and abdomen. Mesothelioma is linked with exposure to asbestos fibres and can take 30 to 40 years to develop. There is no proven cure. Australia has the highest asbestos mortality per capita in the world, and for the next 20 years around six Australians are expected to die every day from asbestos related disease. Currently, approximately 600 cases of mesothelioma are recorded annually, and the incidence and mortality rates for the disease for women have doubled in the last 10 years. We can expect another 11,000 cases to appear between now and 2020.

Recent clinical evidence shows that median survival rates for mesothelioma patients increases from 9.3 months from diagnosis to 12.1 months from diagnosis when Alimta is used in combination with Cisplatin, compared to the use of Cisplatin alone. This combined treatment is known as the standard of care among clinicians. Alimta not only increases life expectancy by inhibiting tumour growth but improves a sufferer’s quality of life in its final stages through reduced fatigue, cough, pain and loss of appetite. But, while some victims of mesothelioma are receiving fully subsidised access to standard of care treatment, a new report by the Allen Consulting Group shows that between 35 and 50 per cent of Australian victims of mesothelioma are not getting access to critical treatment for their disease.

There are extreme access inequities between mesothelioma patients in different states, among those attending different hospitals and between those exposed to asbestos via occupational hazard and those who cannot establish how they were exposed. The absurdities of the inequity of access to Alimta are clear: Alimta is available on the PBS to a person who is suffering from lung cancer caused by smoking; it may not be subsidised for a person living in New South Wales who has been casually exposed to asbestos fibres through renovating the family home; workers whose employment in New South Wales exposed them to asbestos fibres will receive Alimta free through the New South Wales Dust Diseases Board, but it would not be available to the wives of workers who were exposed to asbestos while washing their husbands’ asbestos-laden clothes; and the subsidy is available to all sufferers living in Western Australia, including wives, through its public hospital system but it is not available to a person living in South Australia through the same public hospital system.

We are particularly aware of asbestos related disease in my electorate because James Hardie spent 45 years manufacturing asbestos products in Camellia in the heart of the Parramatta electorate. It started operation in 1937 and ceased making asbestos products in 1983. James Hardie was thought of as a good employer. Whole families worked there—fathers, sons and brothers. Bernie Banton and his brothers left school in the seventies to work in the local factory. Ted, the oldest brother, got his younger brother a job at James Hardie. Ted died of mesothelioma and the two younger boys, Albert and Bernie, both contracted asbestosis. Bernie, still a father of teenage children, has also contracted mesothelioma.

Treatment for this disease should not be based on how or where it was contracted or whether the victim can afford to pay the $20,000 per course. Victims in this prosperous country should not be forced to fight to receive standard of care treatment or justify why they should receive equal access to treatment. Given the severity of the disease and the havoc that it wreaks on families, this is an issue that simply cannot wait. I commend the motion to the House.

David Hawker (Speaker) Share this | Link to this | Hansard source

Is the motion seconded?

Julia Irwin (Fowler, Australian Labor Party) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

Alan Cadman (Mitchell, Liberal Party) Share this | Link to this | Hansard source

Bernie Banton is a friend and acquaintance of mine also. I think most people in north-western Sydney know Bernie as a fine Australian committed to the cause and carrying the cause for many of his colleagues who suffer this dreadful disease. In Australia we rely on the Pharmaceutical Benefits Advisory Committee to establish which pharmaceuticals should be available and how they should be made available. Members of this House may have sentimental and emotional attachments to particular causes, but it has been the tradition and practice of government after government to refer these decisions to experts, to have experts advise the government and then for the government to finally make the decision as to whether the nation can afford to support a particular product.

The Minister for Health and Ageing, The Hon. Tony Abbott, went on the ABC’s 7.30 Report on 29 August—just a couple of weeks ago—to indicate that the second application by the manufacturers of Alimta, the product that we are speaking about, will get a fair hearing from the PBAC in November at its November meeting. This is the second application made by the firm to have their product recognised. The PBAC is required to consider the clinical effectiveness and the cost benefit and value for money of the proposed medicine as compared to other available treatment. Alimta is listed on the PBS as ‘for locally advanced or metastatic non-small cell lung cancer, after prior platinum-based chemotherapy’.

The PBAC recommended the listing of Alimta for the treatment of non-small cell lung cancer as it was shown to be as effective as other therapies that are subsidised for this condition and no more expensive. It is basically for those who are suffering from lung cancer caused by smoking. It may seem unfair that smokers with non-small cell lung cancer receive this drug and others may not. However, not all non-small cell lung cancer is caused by smoking; there are other reasons for the development of non-small cell lung cancer apart from smoking.

Previous submissions to list Alimta for the treatment of pleuromesothelioma were unsuccessful because the effectiveness of this drug in the treatment of the condition has not at this point been demonstrated. It is going to come before the PBAC in November, and the company will be putting the case to the panel of experts that we rely on to assess these things. At this point the expert body can make another assessment of whether this particular product combined with other drugs is going to be successful or not. I think in the first demonstration it was shown that on its own it was not successful, but overseas it has been used with other products and in that instance has been proven, so the company says, to be successful. The company has made it public that the new submission will be going forward, and I know that the committee will be considering it.

Up to $42 billion will be provided by the government to states and territories over the next five years to support medical and health programs, and it has been chosen by the Western Australian government to pick up the cost of this product. The Commonwealth, if it is so indicated, will be able to consider the report of the committee when it comes forward with its recommendations approximately six weeks after the November meeting. I know that for many people involved with mesothelioma time is a critical factor. Whilst delays are to be regretted, the decision is only weeks away, not years away. The government will at that time, with proper advice and under proper consideration, be able to give advice to all sufferers and families of sufferers.

Julia Irwin (Fowler, Australian Labor Party) Share this | Link to this | Hansard source

The words ‘fibro’ and ‘western suburbs’ go together like ham and eggs. In Sydney and most other capitals, regional cities and towns, the housing boom of the postwar period was dominated by the use of asbestos cement sheeting. This material was inexpensive, easy to work with and easy to apply. Like millions of other Australians, I was raised in a fibro home. Other forms of asbestos were widely used in industry for heat insulation, and many workers were exposed to asbestos in its raw form. But this wonder material hid a deadly secret.

By the mid-1960s, contact with asbestos was linked to fatal lung diseases. Mesothelioma is a rare and fatal form of cancer caused by exposure to asbestos. Diagnosis occurs often as long as 20 to 40 years after exposure. From then, the survival rate is only 42 per cent for one year and five per cent for five years. There are at present over 600 cases of mesothelioma, with an expectation that there will have been 18,000 cases by 2020. This is the highest rate in the world.

The standard treatment of mesothelioma is a combination of agents Cisplatin and Alimta. A single course of treatment of Alimta currently costs between $20,000 and $25,000. Alimta is not listed on the PBS for the treatment of mesothelioma, leaving some sufferers to meet the full cost of this treatment.

In New South Wales, sufferers who can prove that their case was caused through their employment may have their treatment funded by the Dust Diseases Board as workers compensation. Access to free treatment varies from state to state. Western Australia provides universal access through public hospitals. In some cases, private health insurance may cover the cost where the treatment is given as an in-patient service. In the case of New South Wales, access to treatment can be delayed waiting on approval from the Dust Diseases Board. Treatment with Alimta is most beneficial when it is begun in the earliest stages of the disease. Any delay can reduce its effectiveness.

While Alimta is included on the PBS for other forms of lung cancer, it is not approved for mesothelioma. Funded access to Alimta for the treatment of mesothelioma across Australia is an absolute dog’s breakfast. Between 35 per cent and 50 per cent of mesothelioma sufferers who would benefit from a course of Alimta experience problems obtaining subsidised or compensated access to treatment.

While the extension of survival may only be from 9.3 months to 12.1 months with the use of Alimta, what needs to be considered is the improvement in the quality of life for sufferers. Diagnosis with mesothelioma is a death sentence. There is no cure. Early treatment with Alimta can extend the survival of sufferers but, more importantly, it can make a big difference to the quality of life of sufferers. It can mean the difference between being confined to a bed and being able to move about. It can make a huge difference to the level of pain encountered.

The importance of this cannot be underestimated. For those now diagnosed with mesothelioma and the tens of thousands whose diagnosis will be revealed in the years ahead, the prospect of facing a lottery when seeking the best available treatment should not be happening in our health system. A factor in survival for sufferers is reducing stress levels. Putting sufferers through a series of hoops to gain access to treatment is cruel and heartless. To deny access to treatment which reduces pain in the disease’s terminal stages is shameful. We would not treat animals the same way we treat victims of mesothelioma. At a time when our budget surplus is growing, we should be able to find the $5 million a year to fund the treatment of mesothelioma using Alimta.

The government must act with the greatest urgency to provide relief for the hundreds of mesothelioma sufferers in need of treatment, and it must act now to improve hope for the thousands of people who, in the years ahead, will be diagnosed with mesothelioma across those towns and suburbs where we are surrounded by fibro. This is a national disaster on a scale not seen before in this country. (Time expired)

Peter Slipper (Fisher, Liberal Party) Share this | Link to this | Hansard source

I would like to commend the honourable member for Parramatta for raising this motion in the House. We are fortunate in this country to have a Pharmaceutical Benefits Scheme which really is world first-class. What the government must always do is make sure that the scheme remains affordable so that—unlike in schemes in other countries, including New Zealand—important lifesaving drugs are able to be included on the Pharmaceutical Benefits Scheme.

We cannot have a situation whereby anyone can get any drug listed on the scheme at whim, because many of these drugs are inordinately expensive and sometimes the benefits of these drugs are not always easily and quickly proven. We therefore have what many would describe as a very appropriate and accountable system for listing medicines on the PBS. The Australian government relies on the advice of the Pharmaceutical Benefits Advisory Committee. This is an independent expert committee.

I have read about the prognosis for sufferers of mesothelioma and, as the honourable member who spoke before me mentioned, it is not good. It does seem as though Alimta provides additional quality of life as well as an extension of life. The honourable member mentioned in her speech that, while the extension of time of life may not be substantial, the quality of life is substantially improved. I am not a medical person and I am not really in a position to know whether that is in fact the case, but I am happy to accept what the honourable member says she believes and I am happy to take it at face value.

I understand that a prior application was made for the use of Alimta on the Pharmaceutical Benefits Scheme to fight mesothelioma and that that was unsuccessful because the committee considered that it was not adequately proven that the benefits that would flow from listing it as well as the improvement in health outcomes warranted the cost. My understanding is that there has now been a new submission made for Alimta to actually be listed for the treatment of malignant pleural mesothelioma in combination with Cisplatin and that the November 2007 meeting of the Pharmaceutical Benefits Advisory Committee will consider that further application.

My experience of the way this committee operates is that it does look at all of the points put before it and it does try to come up with a rational and appropriate response. That does not mean that on every occasion the committee does get it right, but we simply could not substitute the current system with a system whereby whatever drug was desired to go on the PBS would or would not go on depending on the degree of pressure that was placed on the health minister at the time. Drugs have to be listed in accordance with their medical benefits and in accordance with the advantages, provided that the drugs are provided by companies at a reasonable cost. This is what the committee must take into account when determining whether or not to recommend the listing of a particular medicine.

Speaking personally, given all the material that I have read, I am strongly supportive of the listing of this drug on the Pharmaceutical Benefits Scheme. But I do make that statement with the caveat that I am not a medical person and I am not medically competent to make that decision. The written evidence that has passed before me indicates that this drug would indeed improve the quality of life of sufferers of mesothelioma as well as improve the length of life that sufferers of this disease actually have. So in that sense I feel well disposed towards the principle of listing it and I hope that when the Pharmaceutical Benefits Advisory Committee considers this matter again in a couple of months time it will be able to look very closely at the case being put forward by the company—and I hope that the case is compelling and cogent—and as a result decide Alimta will be able to be listed on the Pharmaceutical Benefits Scheme for mesothelioma sufferers. Having said that, I am really proud that this government has endeavoured to make sure that our Pharmaceutical Benefits Scheme remains viable and— (Time expired)

Anthony Byrne (Holt, Australian Labor Party, Shadow Parliamentary Secretary for Foreign Affairs) Share this | Link to this | Hansard source

I rise with pleasure to support the motion before the House that was moved by the member for Parramatta. I do so having met two very brave people that are fighting the ravages of mesothelioma and also having heard of their hopes and aspirations as to this treatment using Alimta in conjunction with Cisplatin and for Alimta, in particular, to be listed on the Pharmaceutical Benefits Scheme. We have heard during the discussion in this place from people who do not have experience of suffering mesothelioma about the process through the Pharmaceutical Benefits Advisory Committee. In my view, the reason this motion has come before the House is the great measure of concern of those that advocate on behalf of those with mesothelioma who are seeking recourse to this treatment. On the three previous occasions when they believe that a justifiable case has been put to the Pharmaceutical Benefits Advisory Committee for the listing of this particular drug, this drug has not been listed on the Pharmaceutical Benefits Scheme. That has indeed caused them a great measure of concern.

The fact is that the advisory groups that act on behalf of those that are experiencing the ravages of mesothelioma—and I would like to mention the Asbestos Diseases Society of Victoria and its director, Leigh Hubbard—have a great deal of concern about where this is going. There is no certainty as to this particular matter being considered by the Pharmaceutical Benefits Advisory Committee. There has been some discussion about the cost and about the fact that we cannot bring every new-generation drug onto the market, however much hope the drug itself might offer to those that are experiencing the difficulties of fighting for their life. It is interesting that that argument has been put because that was the same argument that was put for those that were not strongly supportive of Herceptin being listed on the Pharmaceutical Benefits Scheme. In fact, I can recall—and there is an eerie similarity here between those that are now advocating for Alimta to be listed on the Pharmaceutical Benefits Scheme and those that were advocating for Herceptin—very similar arguments where you would have women who had HER2 breast cancer and their treatment would cost not between the $15,000 and $20,000 that has been proposed for Alimta but between $65,000 and $90,000. In the case of Herceptin it was a life-saving treatment but in the case of Alimta it is a treatment that, as early studies are indicating, can prolong life expectancy and—very importantly for those that are fighting for their lives, literally fighting to breathe—ease suffering and offer a greater degree of optimism as to the capacity to cope with life.

Particularly when we are talking about the costs, and given the cost of treatment with Alimta is between $15,000 and $20,000, if you extrapolate them out—given the number of people that are projected to need access to this particular drug—we would be talking, if it were to be listed on the Pharmaceutical Benefits Scheme, about $33 million over five years. I am really struggling, as I stand in this House, to understand that we have a $17 billion cash surplus on one hand and on the other we are having an argument about a $33 million amount of money to be spent over five years, particularly when we are seeing campaigns advertising Work Choices legislation, that has not even been brought into the House, at a cost of $50 million.

How can anyone sustain such an argument particularly when you have countries that have in fact listed for reimbursement Alimta for the treatment of mesothelioma? These are countries such as Japan, Korea, Austria, Belgium, the Czech Republic, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, the Netherlands, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and, most recently, the UK. All of these countries have referred to studies which have been before the PBAC, such as the one that I now hold, which is a phase 3 study of pemetrexed in combination with Cisplatin versus Cisplatin alone. This is from eminent leaders in the field and it proves that this treatment works. So we are talking about $33 million over a five-year period of time and we are asking that this drug be listed by the PBAC not only to potentially prolong people’s lives but also to ease their suffering. If we call ourselves a civilised society and if we call ourselves a community that cares about people, we would list this drug. (Time expired)

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

Members have risen in this House numerous times to support the provision of life-saving and life-enhancing drugs, and this is yet another occasion. We have heard a lot of the speakers go through the issues of mesothelioma sufferers and their inability to access a choice of medication. It has been stated in the debate that the PBAC has rejected past submissions for the use of Alimta for mesothelioma on a wide scale but that it has indicated that there was not enough evidence and that any improved survival was accompanied by improved quality of life. The PBAC has said that Alimta treatment maybe did not represent value for money, that Alimta can have toxic effects and that patients with mesothelioma are more likely to develop serious side effects than those patients with non-small cell lung cancer.

The PBAC is an independent advisory board. This is a bipartisan issue; it is not a political issue. There is an independent board to assess these applications. Those on the board are the appropriate medically trained people to assess the applications of all drugs that may be looked at to treat certain illnesses, so it is appropriate that they assess it. I ask the PBAC, as an independent advisory body, to consider whether, if Alimta does not agree with a patient and the side effects are intolerable for that patient, the patient will use it. The issue here is that sufferers of mesothelioma must be provided with a choice. It is also a fact that there are patients who react favourably. We have heard about those who do not react favourably to Alimta, but there are those who do react favourably to the combination treatment of Cisplatin and Alimta and, for these people, multiple courses of the treatment may be required. Of course, these courses cost much more. If a single course can cost up to $25,000, then if Alimta is agreeable to the body it will cost a lot more money.

It is for this reason that some sufferers are not made aware of the possible option of Cisplatin and Alimta. It is suggested that some clinicians choose not to discuss these options with somebody who may not be financially able to consider this treatment; or a surgeon may consider that it is beyond the means of their patient to access this treatment so they do not discuss it. But it is also noted that mesothelioma patients in rural and regional areas are less likely to be diagnosed with this disease or to be diagnosed correctly and informed about Alimta. This is an inequity of different proportions for different areas and for the many patients and sufferers who would get enormous advantage from the use of Alimta.

We heard some significant stories the other day, and anyone who has had personal dealings with mesothelioma, or cancer in general, will always hear a heartbreaking story. We have heard many stories, provided by many strong and courageous mesothelioma sufferers, which have really convinced me that, as a bipartisan effort, the PBAC needs to sincerely look at the positive values that can be provided to the sufferers of mesothelioma who can adequately take this treatment without side effects. Bodies react differently to every sort of treatment, but this treatment must be made available as a choice of treatment. If you are racked with mesothelioma and pain, any treatment or assistance to reduce that in your last stages of life are welcomed and should be made available.

Alex Somlyay (Fairfax, Liberal Party) Share this | Link to this | Hansard source

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.