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NHS cancer patients still denied treatments available in other countries

Appraisals system should be reviewed, say breast and prostate cancer charities

Caroline White

Monday, 15 August 2016

NHS cancer patients in the UK are still missing out on innovative treatments that are available in some comparable countries of similar wealth, say charities Breast Cancer Now and Prostate Cancer UK in a report* published today.

This is partly down to the appraisal systems used and their inability to negotiate on the price of drugs, says the report, which recommends an overhaul of the process.

The report reviewed the roles of Health Technology Assessment (HTA) bodies, such as the National Institute for Health and Care Excellence (NICE) in England and Wales and the Scottish Medicines Consortium (SMC) in Scotland, in assessing which new drugs are routinely made available on the NHS.

And it compared the availability of breast and prostate cancer treatments in England, Scotland, and Wales with five similar countries: Germany, France, Australia, Canada and Sweden.

While no country is perfect, there are elements of other health systems which could be assessed with a view to seeing if access to cancer drugs could be improved for NHS patients, it suggests.

Outside the UK, there is usually a split between two bodies: the HTA body that assesses the clinical effectiveness of a drug doesn’t also decide whether it is cost effective. In England, Wales and Scotland, NICE and the SMC, respectively, do both these tasks, but they don’t have any flexibility to negotiate with industry on price, it points out.

In these other countries, one HTA body makes clinical recommendations which then inform negotiations between government bodies and pharmaceutical companies. NICE and the SMC have responsibility for both functions.

NICE has not approved a single new breast cancer drug for routine use on the NHS in the past seven years, while just two treatments have been approved by the SMC in that time.

Following on from recent changes to the Cancer Drugs Fund (CDF), both charities are now concerned that access to new medicines in England may just become more restrictive. NICE will be entirely responsible for assessing new CDF drugs, yet the CDF was set up to counter repeated rejections of new cancer treatments by NICE, says the report.

For example, breast cancer drug Kadcyla, which was launched two and half years ago and is now available in Germany, Canada and France, can only be accessed through the CDF in England, and is not available at all in Scotland or Wales.

Both charities are now calling on the health secretary to review the current role of NICE, alongside the renegotiation of the Pharmaceutical Pricing Regulation Scheme in time for 2018, so that price negotiation can be brought into the appraisals system.

Drug prices could, for example, be increased or decreased after launch based on follow-up data from trials and different prices could be allowed for different indications of the same drug, as is the case in France—known as ‘multi-indication pricing’—recommends the report.

Current methodologies should be reviewed so that they are able to respond effectively to the new generation of treatments that are on the horizon, it says.

UK countries should also review their respective systems to ensure that the HTA process plays a key role but is part of a wider process, as happens elsewhere.

And the way drugs are assessed should be reformed to ensure that the process takes account of patients’ views of the full benefits of new drugs, because although UK systems have the most robust patient engagement, it is not leading to greater patient access, and currently benefits are assessed on a small sample of measures, ignoring crucial aspects like level of fatigue (a common symptom of prostate cancer), says the report.

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said: “That NHS patients are being denied access to innovative new breast cancer drugs, while other countries are finding ways to make them available, is totally unacceptable.

“This report demonstrates the need for serious reform of the way our health system assesses, and determines the availability of, the cancer drugs that patients rely upon.”

She continued: “Pharmaceutical companies must indeed start offering more responsible prices. But until our health bodies are empowered to negotiate the price of cancer drugs, patients in the UK will continue to miss out on new treatments being offered elsewhere.”

Heather Blake, Director of Support and Influencing at Prostate Cancer UK, added:

“Making all new cancer treatments available to patients is of course made challenging by finite NHS budgets that are stretched to capacity and running at a deficit. But men cannot continue to spend years fighting for access to every new prostate cancer treatment. They need a more streamlined system for assessing and appraising cancer drugs which makes the right decisions first time around.

“Although last month’s CDF reforms aim to address this issue, they place all the responsibility for patient access to new and innovative treatments on the pharmaceutical industry’s willingness to lower its prices meaning that cancer patients once again have the potential to be left in limbo.”

* International Comparisons of Health Technology Assessment. A report from Breast Cancer Now and Prostate Cancer UK

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