Means towards better access to cancer medicines globally

Liesbeth de Vries is a medical oncologist at the UMCG. Medical oncology was still very much in its infancy when she just started, but De Vries has seen the field develop spectacularly during her career. One of the biggest challenges medical oncologists now face is making sure everybody in the world can access new and often expensive medicines.

As the Cancer Medicines Committee chair of the European Society for Medical Oncology (ESMO) (since 2017), she aims to enhance access to cancer medicines. An important instrument to achieve this is the ESMO Magnitude of Clinical Benefit Scale (MCBS) she helped develop (2013-now, chair 2015-2019). This scale assesses the benefits cancer medicines have for patients and enables patients, governments, and health insurers to choose those medicines with the most impact. The tool's goal is to enhance the efficiency of resource allocation in healthcare systems. 

Overcoming scepticism

After the initial drafting of the scale by medical oncologists and biostatisticians, the scale was field-tested, and patient consultation was performed.  The development of the ESMO-MCBS was initially met with scepticism by quite some colleagues of De Vries: “Some people within my profession were afraid it would endanger our relationship with the pharmaceutical industry and with that the development of new medicines.” However, while the ESMO-MCBS was developed, the problem of expensive and inaccessible medicines in oncology grew. Society and colleagues in the field alike now started to embrace the project. This incentivised the ESMO-MCBS working group to update the scale. Moreover, workshops are given to stakeholders, including patients and the pharmaceutical industry. 

The societal impact of the Magnitude of Clinical Benefit Scale

The uptake of the Magnitude of Clinical Benefit Scale by the (public) health sector has been impressive. The scale is used by an array of health assessment technology organisations, not only in Europe but also in South America. This has provided the momentum needed for a further spread of the tool.

Because of De Vries’ role in developing the tool, she became member of the 22nd and the current 23rd expert committee on Selection and Use of Essential Medicines for the globally recognised Essential Medicine List (EML) of the World Health Organisation. The ESMO-MCBS tool is used as a gatekeeping mechanism for this list. This means that only medicines scoring a 4 and 5 in the non-curative setting or an A and a B in the curative setting with this tool will be considered for the EML.

But the societal impact of the ESMO-MCBS does not stop there. The Cancer Medicine Committee of ESMO together with the London School of Economics aims to develop a reimbursement model indicating what a fair price for a particular medicine is and helping countries negotiate with the pharmaceutical industry. 

Patient participation

The success and societal relevance of the ESMO-MCBS are in no small part due to patient participation in the development process. This process of patient participation is ongoing; workshops given to patients also serve to get feedback just as much as they are used to educate patients.