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Cancer drug access in England is a ‘debacle’

Doctors call for unified and sustainable system for evaluating new medicines

Louise Prime

Tuesday, 08 September 2015

Doctors and patient groups are furious at the Government’s “abject failure” to address problems in ensuring fair access to effective and life-prolonging cancer drugs. They argue that the latest “prioritisation” of the list of drugs included in the Cancer Drugs Fund (CDF) is a prime example of the confusion at the heart of the drug assessment system.

The CDF said that despite previous cost-containing action, it was still facing a £70m overspend this year, which it said could be used for other aspects of cancer treatment or other NHS patients. To ensure that “every penny is spent on the best available drugs, at appropriate costs”, it conducted a further review of the effectiveness of treatments that it funds; it said all its decisions on drugs to be maintained in the CDF were based on the advice of clinicians, the best available evidence, and the cost of the treatment. As a result of the review, some medicines have now been removed from the list.

CDF chair, oncologist professor Peter Clark, said: “We face a difficult set of choices, but it is our duty to ensure we get maximum value from every penny available on behalf of patients. We must ensure we invest in those treatments that offer the most benefit, based on rigorous evidence-based clinical analysis and an assessment of the cost of those treatments.”

But the charity Myeloma UK said the “devastating” decision to remove from the list pomalidomide (Imnovid) and lenalidomide (Revlimid) at first relapse was a “significant step backwards” in the treatment of the rare bone cancer. Although patients already taking the drugs will not have them stopped, relapsed patients will no longer be able to access them on the NHS; lenalidomide still has NICE approval for use at second relapse.

Myeloma UK’s chief executive Eric Low said: “Myeloma UK has consistently argued that the Cancer Drugs Fund does not address why drugs are not being approved by NICE, and that the Fund is not a long-term solution to underlying access issues.

“This is compounded by the fact that the Government has been far too slow to see and address the critical flaws of the Fund. It has let things develop to the stage where effective and life-prolonging drugs are being brutally delisted from the Fund to cut costs. Other Government attempts to improve the situation, most notably through the pharmaceutical price regulation scheme (PPRS), have also been an abject failure. Taken together, the Government has systematically failed to improve access to cancer medicines in England and should be held to account for this debacle.”

He called for an end to top-down Government cost-cutting and for sustainable, system-wide solutions to the problems of development and access to new drugs in the UK. Otherwise, he concluded, the goal to save 30,000 lives a year in the new cancer strategy would remain “merely a pipe-dream”.

Professor Paul Workman, chief executive at The Institute of Cancer Research, London, concurred. He said: “Today’s decision is an example of the confusion at the heart of our drug assessment system – with some treatments first being refused by NICE, then accepted onto the Cancer Drugs Fund and now to be removed from the list and denied to new patients. What we urgently need is a new unified system for evaluating treatments that can attract widespread support and ensure that the most innovative and effective cancer drugs reach the patients who need them as fast as possible.”

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