The cost of high tech treatments – that if these become “universal” then the low cost high volume treatments need to be paid for.

Chris Smyth in The Times 19th December 2015 reports: NHS cost battle over cancer ‘vaccine’

This is only the start. Technology in health is advancing faster than our ability to pay, or our ability to discuss the philosophy and ethics rationally. Other cancer vaccines will follow this one. The cost of such technically advanced treatments is usually very high –  if these are to become “universal”, and nobody is to be excluded, then the low cost high volume treatments and services need to be paid for somehow. The principal NHSreality advocates is overt rationing, usually at the lower cost end, but occasionally at the high cost end of the curve… Open rationing will at least be honest. The more we ration at the high cost end, the more inequitable society becomes… But buying an extra 3 months of palliative care is not attractive to most of us. All of us are getting wealthier (on average) but the differences between us are getting larger.. (The richer are getting richer faster) Social justice demands that we make treatment opportunities as equitable as we possible can afford..

cancer treatment that uses the cold sore virus to vaccinate the body against tumours has been approved by regulators, paving the way for an NHS battle over cost.

The drug is the first to use a genetically engineered virus to stimulate the body’s natural defences and has eliminated tumours completely in some patients.

Many specialists believe that medicines to harness the body’s own immune system will transform treatment, allowing some patients with previously inoperable cancers to be effectively cured.

However, the high cost of such treatments has prompted criticism both of drug companies and the inflexibilities of the NHS drug assessment system, which ministers have pledged to overhaul. Earlier this week another immunotherapy drug, nivolumab, which costs £5,700 a month, was rejected as too expensive for lung cancer patients.

T-VEC, which was approved for routine use in advanced skin cancer yesterday by the European Medicines Agency, is the first such drug to use a virus both to attack cancer directly and to prime the immune system.

“It’s vaccinating people against their own cancers from within,” said Professor Kevin Harrington, of the Institute of Cancer Research in London, who ran the drug trials. The virus is designed to only attack cancer cells, commandeering them to pump out proteins which act as a “red flag” for the immune system.

A trial reported earlier this year that the drug doubled survival of patients with advanced skin cancer to 41 months on average. For 10 per cent of patients, tumours vanished entirely and were still gone three years later. The drug also has relatively few side effects.

More than 13,000 people a year in Britain develop melanoma, the most aggressive form of skin cancer, and more than 2,000 die.

Doctors hope that by combining T-VEC with other immunotherapy drugs, more patients will make recoveries. At the world’s largest cancer conference early his year, experts marvelled at the “spectacular” success of a series of immunotherapy trials for cancers of the lung, skin, kidney liver and head.

Professor Harrington said: “I’m really excited by the endorsement by the European Medicines Agency. It is an important first step that paves the way for T-VEC being made available for patients with metastatic melanoma — a cancer that has largely been regarded as untreatable for the majority of patients. The National Institute for Health and Care Excellence has already started evaluating the treatment, and I hope there are no delays in making it available to patients on the NHS.”

Nice is due to make a decision by July next year. Amgen, which manufactures T-VEC, also known as Imlygic, said that a price had not been set, but suggested a discount would be available for the NHS.

“There’s a belief that we can partner Nice and the NHS to make this medicine available to patients who need it,” a spokesman said.

The Institute of Cancer Research urged the company to be realistic about what the NHS would pay when setting a price.

The licensing approval means that the drug can be prescribed privately.

Sean Harper, the executive vice-president of Amgen, said the approval “is an important milestone for this new class of drugs, bringing patients with a rare and deadly form of skin cancer a much needed new treatment option.”

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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