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Case 1Role play “Rejuvimab”
Johan suffers from a rare and fatal form of leukaemia. He is expected to die within three
months. Until recently no treatment was available to treat this illness. However, a new
medicine called "Rejuvimab" has recently been licensed for patients suffering from this
disease. This medicine cannot cure the condition. For some, it may prolong their lives by up
to one year. For other patients, however, it may even cause side-effects that may actually
shorten their lives. Because the illness is rare, the price of the medicine is high; it is
estimated to cost 100,000 Euro per QALY.
Johan wants to be treated with "Rejuvimab". His daughter is getting married in May next
year, and he would love to live long enough to "give her away". He is willing to take the risk
that it might not work. Johan's doctor says that the treatment is suitable for Johan and has
agreed to administer the medicine and supervise the care.
However, Johan's health insurer has noted the "opportunity costs" of "Rejuvimab". The
insurer has a finite health care budget and is concerned that the medicine has limited clinical
effectiveness. It is concerned about single, high-cost treatments because, in common with
other health insurers, it is being urged by government to spend more on preventing cardio-
vascular diseases and stroke where the use of "statins" can save more lives in future years.
Question
Since the health insurer denies Johan access to cost-coverage for “Rejuvimab”, Johan
challenges that decision in front of the national court.
What would be the outcome of such a Court ruling, and based on what
principles/rights?
Parties involved:
Johan
Oviedo Convention explanatory report: Art.3: Equitable access to health care par.
25, 26
ECHR: Art.2: The right to life, Art.3: Prohibition of torture, Art.8: Right to respect for
private and family life
Health insurer and Government
Oviedo Convention explanatory report: Art.3 par.25, 26
International Health Law (book):GC 14 page 20 art.8, 12, page 25 art. 12 par 19,
47, 52
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