On the theme that governments should focus on populations, and doctors on the individual patient, the Cancer Drugs Fund is an obvious example of the paradox. The Cancer drugs fund (NHS England) is illogical. If it is spent on cancer, more money should be spent on radiology and radiotherapy, but what about Mental Health? …And it could be right to ration some of the most expensive services. The UK politicians should say/publish this paradox overtly and honestly to their citizens. The first party to do so may be surprised by the level of public support. I apologise for reprinting the whole article.. but felt it too important to omit… It provides a perverse incentive to overtreat and leads NHSreality to wonder about the lobbying by big Pharma to both politicians and doctors .. (The Reith Lectures 2014 – Being Mortal – Don’t miss out on modern philosophy of medicine.) I expect the Chief Medical Officer (CMO) would agree with Prof Sikora if he was put in the dock by a barrister..
“ENGLAND denied miracle bone cancer drug”. A few years ago that sort of headline was common in newspapers. The accompanying stories tended to explain that the National Institute for Health and Care Excellence (NICE), which advises the NHS, had rejected a cancer drug as too expensive. David Cameron, who worked in public relations before becoming a politician, decided to do something. In 2010 his government created a Cancer Drugs Fund to pay for medicines rejected or not yet evaluated by NICE. The headlines diminished. But now they are back.
Since it was set up, the budget of the Cancer Drugs Fund has grown from £200m to £280m ($423m). That is to be expected. The whole point of the fund is that it vets drugs quickly and less stringently than NICE. So as the number and cost of cancer drugs increases, so does spending. But the fund has overspent: last week 25 treatments had to be struck off the list. On January 19th a new group, involving the health department, NICE, the Association of the British Pharmaceutical Industry and various cancer charities, met to work out what to do with the fund. It is likely that NICE will take over some of its work. But a more drastic remedy would be kinder.
Whereas NICE weighs the cost and benefits of drugs and is often able to drive down prices, the more accommodating Cancer Drugs Fund pushes them up. Eisai, a drugs company, once offered NICE a breast-cancer drug “at the lowest price [it] ever offered”, according to Gary Hendler, the company’s president. After NICE rejected the application, the company charged the Cancer Drugs Fund one of the highest prices in Europe for it (in France, a vial costs about a third less). And a high price in Britain can make it difficult for health bodies in other countries to negotiate prices down.
The fund could probably be made more discerning. But it would be better to do away with it altogether. According to a cost calculator developed at York University, if the £230m spent on the Cancer Drugs Fund between April 2013 and April 2014 had instead been spent in the wider NHS, it could have added over 17,800 “quality-adjusted life years”—a measure that combines survival and quality of life. It estimated that the Cancer Drugs Fund added less than 3,400 during that time.
Oddly, the fund may even have short-changed cancer patients. It considers only drugs. Surgery and radiotherapy need money too, and they respectively account for around 49% and 40% of cancer cures; chemotherapy accounts for only 11%. The damage to the NHS is also political. The existence of the Cancer Drugs Fund suggests that NICE is not up to the task of vetting cancer drugs—last week the fund’s chairman told Westminster Health Forum he regretted that the Cancer Drugs Fund had undermined NICE.
The outcry over the drugs cull is a sign of the political burden the Cancer Drugs Fund will become. It will need regular trimming, but that will provoke the very headlines the fund was set up to avoid. Worse headlines, in fact: whereas NICE has evidence-backed reasons for its decisions, the Cancer Drugs Fund does not. Dismantling the fund would be even harder, were any government minded to do so (Labour has pledged to preserve and extend it). Cancer’s emotive power, which made it easy for Mr Cameron to get support for his fund, makes it all the more painful to appear to give up fighting it.
Clarification: Eisai, the pharmaceutical company mentioned in this article, has asked us to make it clear that the Cancer Drugs Fund has lacked a mechanism through which drugs companies might lower the prices of their products. The company says it was not given an opportunity to reduce the price of Halaven, the breast-cancer drug alluded to in the article, before the NHS abruptly decided to stop paying for that drug through the Cancer Drugs Fund. We are happy to clarify this.