OHS REPS @ WORK

The intense campaign run by unions and asbestos support groups to make Alimta available as a treatment for mesothelioma sufferers has been successful.   

Mesothelioma sufferers are to get cheaper access to the treatment drug Alimta via the Pharmaceutical Benefits Scheme (PBS).

Many thousands of people, including the reps who attended the OHS Reps conference, sent letters and signed petitions and postcards which were then forwarded to both the Health Minister Tony Abbott and the ALP shadow Health Minister Nicola Roxon, as well as to the PBS.  

The decision by the Pharmaceutical Benefits Advisory Committee comes a week after a delegation of union representatives and asbestos sufferers attempted to hand Tony Abbott a petition calling for the listing. The delegation included Martin Kingham, CFMEU National Assistant Secretary, Tony Medina, former CFMEU organiser and Victorian asbestos campaigner, and noted anti-asbestos campaigner and mesothelioma sufferer, Bertie Banton. At the time Mr Abbott was forced to apologise for questioning Mr Banton’s integrity.

Leigh Hubbard, Executive Officer of the Asbestos Diseases Society of Victoria, hailed the decision as a victory for common sense and community pressure. “Alimta is of proven benefit to mesothelioma patients, is subsidised in nearly every developed country including many less prosperous than Australia, and provides improved quality of life. Yet it has taken an enormous groundswell of support to have Alimta recommended for the PBS.”

Both sides of politics support the now support the inclusion of Alimta on the PBS. ALP Health Shadow Minister, Nicola Roxon, has said an ALP Government will subsidise Alimta and Health Minister, Tony Abbott, has finally announced that the Liberal Party will do the same.

The next stage in the process will see the new Federal Government work out the level of subsidy for the drug with the manufacturer Eli Lilly. It is hoped that the drug will be added to the PBS by January 2008.

Read more: AMWU feature article  CFMEU Media Release

Background to the campaign:

Information from the Asbestos Diseases Society of Victoria (ADSVIC)

What is Mesothelioma?

Mesothelioma is a rapidly fatal cancer of the lining of the lung, usually associated with exposure to asbestos[i]. Australia has the highest rate of mesothelioma in the world[ii].

Mesothelioma is generally diagnosed 20 to 40 years after asbestos exposure. There has been a four to five-fold increase in the rate of mesothelioma since the early 1980s[iii], fuelled by exposure to asbestos during the mid 1900s. It is estimated that this rate will continue to increase for the next five to 10 years, with peak incidence between 2015 and 2018.

Mesothelioma patients have been exposed to asbestos by no fault of their own. The dangers of asbestos only became widely publicised in the 1980s. Those at highest risk include anyone who has worked with asbestos, and their family members, in jobs such as mining, milling, manufacturing, construction, power generation and in the navy, railway and shipbuilding industries[iv]. Many of these industries were government-owned.

Owners and renovators of homes built before the 1980s are also increasingly at risk of asbestos exposure and mesothelioma[v].

What is the standard treatment for Mesothelioma?

Mesothelioma is an extremely difficult cancer to treat. Surgery is possible only in a small number of cases. People who cannot have surgery typically survive only 6 months on average with supportive care only[vi].

Alimta (pemetrexed disodium) is a chemotherapy agent for the treatment of non-small cell lung cancer and mesothelioma. Alimta is the only treatment registered for use in mesothelioma, and in combination with cisplatin, represents the standard of care for mesothelioma treatment in Australia[vii].

When people with mesothelioma are treated with the standard of care their survival time can be significantly increased[viii]. On average, patients survive by more than a year from diagnosis[ix]. In some cases, this can be significantly longer. This time is very meaningful when confronted with diagnosis of a rapidly fatal cancer.

The standard of care treatment combination not only significantly increases patient survival time, but also improves quality of life in terms of fatigue, loss of appetite, pain and cough[x].

Alimta was already listed on the Pharmaceutical Benefits Scheme (PBS) for use in non small cell lung cancer, but was not approved for use in patients with mesothelioma. The manufacturer of Alimta, Eli Lilly Australia, had made three unsuccessful submissions to the Pharmaceutical Benefits Advisory Committee (PBAC) to have Alimta PBS-reimbursed for treatment of mesothelioma. Eli Lilly made a fourth submission to the PBAC, which was to be considered at its November 2007 meeting.  That's why the unions and the asbestos support groups decided on a campaign.

Up to now, access to Alimta for mesothelioma patients is inequitable across Australia. Different states and companies provided various schemes to compensate victims of asbestos exposure, but some patients (especially those with non-occupational exposure) ended up paying for Alimta privately, at great expense. A course of treatment for Alimta over 18 weeks cost in excess of $18,000, excluding other therapies. Patients treated successfully may have needed to pay for multiple courses of treatment.

What action was needed to improve equity of access?

For access to Alimta for mesothelioma patients to be guaranteed nationally, it had to be listed through the PBS. Alimta is subsidised for mesothelioma in most other OECD countries, such as France, Germany, Sweden, Korea and Japan. The expert clinical body in the United Kingdom has also approved its use for patients, recognizing the particular nature of mesothelioma as a terminal disease resulting from asbestos exposure.

Australia has the highest rate of mesothelioma in the world. Australians with this terrible disease will hopefully soon have access to the best standard of care regardless of where they live or how they were exposed to asbestos.

For more information, go to the ADSVIC website.

Countries where Alimta is reimbursed for mesothelioma (not exclusive)

Japan	Greece	Romania
Korea	Hungary	Slovakia
Austria	Italy	Slovenia
Belgium	Latvia	Spain
Czech Republic	Lithuania	Sweden
Finland	Netherlands	Switzerland
France	Norway	Turkey
Germany	Poland	UK

Note: Many of these countries provide reimbursement entirely through hospital settings, however in most cases, reimbursement is universal and not limited by budget. Only Western Australia provides universal cover through hospitals in Australia.

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References

[i] Asbestos Diseases Society of Australia INC, 1997. Asbestos, what you should know. Western Australia, Hart Printing.

[ii] Leigh J, et al. Malignant Mesothelioma in Australia, AM J Ind Med. 2002 Mar;41(3):188-201

[iii] Boyer M, Byrne M, Clarke S. Alimta: a new treatment option for malignant mesothelioma. Reviews in Clinical Oncology, 2003; 1: 4 - 8.

[iv] Asbestos Diseases Society of Australia INC, 1997. Asbestos, what you should know. Western Australia, Hart Printing.

[v] Asbestos Diseases Society of Australia INC, 1997. Asbestos, what you should know. Western Australia, Hart Printing.

[vi] Vogelzang NJ et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with MPM, J Clin Onc 2003, 21(14): 2636-2644

[vii] Vogelzang NJ. Standard therapy for the treatment of malignant pleural Mesothelioma. Lung Cancer 2005; 50 (Suppl.1): S23–4.

[viii] The Cochrane Database of Systematic Reviews 2007. Issue 2: Green J, Dundar Y, Dodd S, Dickson R, Walley T. Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural Mesothelioma. Art. No.: CD005574. DOI: 10.1002/14651858.CD005574.pub2

[ix] N J Vogelzang, J T Symanowski, J J Rusthoven, C Manegold, M Boyer, B Nguyen, P Paoletti, unpublished data.

[x] The Cochrane Database of Systematic Reviews 2007. Issue 2: Green J, Dundar Y, Dodd S, Dickson R, Walley T. Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural Mesothelioma. Art. No.: CD005574. DOI: 10.1002/14651858.CD005574.pub2