title: Subsidised access to new melanoma drugs: in need of further innovation?
abstract: OBJECTIVE
  Melanoma is the most serious of the three common forms of skin cancer. New Zealand and Australia have the highest melanoma incidence rate in the world. A number of new treatments for melanoma with different modes of action have recently become available. Our aim was to examine their availability and subsidized access in New Zealand and to compare their availability and access in Australia and England.
  
  
  METHODS
  We examined the clinical evidence base of the new treatments, their place in treatment guidelines and their consideration for reimbursement by PHARMAC in New Zealand, the PBAC in Australia and NICE in England.
  
  
  RESULTS
  The PBAC and NICE have recommended most treatments and their recommendations have been implemented promptly, using innovative access and pricing models. PHARMAC has rejected most of the new treatments and none has been funded. Pembrolizumab has been recommended with a low priority.
  
  
  CONCLUSIONS
  New Zealand should not be in the unenviable position whereby it has the highest incidence of a fatal disease yet is the last country in the Western world to fund effective treatments for it. We offer recommendations to all stakeholders to break the current access impasse.
authors.affiliation: Wonder Drug Consulting Pty Ltd, Cronulla, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Wonder
authors.affiliation: Auckland DBH Oncology Services Auckland City Hospital, New Zealand.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Fisher
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000600:supply & distribution*; D001315:Australia / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D000074324:Ipilimumab; D008545:Melanoma / Q000188:drug therapy* / Q000453:epidemiology*; D009520:New Zealand / Q000453:epidemiology; D000077594:Nivolumab; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012051:Reimbursement Mechanisms
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074324:Ipilimumab; D000077594:Nivolumab; C582435:pembrolizumab