This story focuses on an expensive high tech treatment which works. There are many others not covered by the media. Covert rationing leads to obfuscation and denial so that Scotland and Wales supplied Abiraterone whilst England did not. Wales approved it in 2012.
Rationing overtly demands that high volume low cost treatments and services were paid by tax paying consumers. Low volume high cost treatments could then be covered by the state. This is exactly what Aneurin Bevan intended in “in place of fear”, and encourages autonomy.
However, assuming the current continuing demographics, with Abirateronewe have the potential for a high volume and high cost treatment. It will be rationed. The media need to focus on the method and ideological beliefs behind the rationing: and whether it is overt of covert.
Thousands of men with prostate cancer will be granted early access to a crucial drug after a U-turn by the NHS.
Abiraterone can delay the need for chemotherapy for years in some men with advanced cancers.
After a three-year battle, the National Institute for Health and Care Excellence (Nice) will approve it today for routine use by the NHS in England.
Patient groups said that the decision was “a very big deal” for men with the most common male cancer in Britain. It will also place fresh attention on the “torturous” process for medicines approval as the government prepares to dismantle its dedicated fund for cancer drugs.
Abiraterone, which was developed in Britain, blocks an enzyme and so prevents the body producing the testosterone required by tumours to grow. After an earlier battle over costs, it was approved for use when both hormone treatment and chemotherapy had failed.
Doctors and charities pushed for it to made available earlier to keep men healthy for longer. In 2014, however, Nice ruled that without the extra funding available to end-of-life drugs, the medicine’s cost of £36,000 a year made it too expensive.
After prolonged haggling, Janssen, which makes the drug, offered a 20 per cent discount and promised to repay the costs of treating any patient who was on abiraterone for more than ten months. Nice also held out for evidence from the United States showing that for some men the drug had continued working for four years. On average men given the daily tablets survived for an extra four months.
Today Nice will give men in England access to the drug before chemotherapy, following Scotland and 95 other countries where it is already available.
Hugh Gunn, a trustee of the patient charity Tackle, said: “After a long and torturous process, Tackle is delighted that abiraterone has finally been passed by Nice for patients who have not yet received chemotherapy. This life-saving drug has helped to dramatically improve and prolong patients’ lives and now more men and their families can continue to benefit from this.
“It’s a very big deal because it works better pre-chemotherapy than post-chemotherapy. Chemotherapy damages you. If you can hold that off as long as possible the better your options are. Abiraterone is a very good drug and it’s a shame that it has taken so long for Nice to make up its mind.”
More than 47,000 men a year develop prostate cancer in Britain and more than 10,000 die. Patients are typically offered hormone therapy alongside radiotherapy or surgery, but if hormones stop working there were until recently very few options.
Abiraterone and enzalutamide, another drug recently approved by Nice for use before chemotherapy, have raised hope that more men will now be able to live longer. Abiraterone had been available on the government’s Cancer Drugs Fund (CDF), a £340 million budget that had blunted controversies over new medicines.
Following a series of overspends, however, the fund will no longer offer patients drugs rejected by Nice. Instead it will become part of Nice’s own assessment process by collecting “real-world” data on how well drugs work.
Sir Michael Rawlins, a former chairman of Nice, recently said described the fuand as “stupid” because it stopped companies doing deals such as the one offered by Janssen.
Defenders of Nice will regard today’s decision as proof that the body can squeeze out better value for the NHS when companies cannot charge the CDF whatever they like.
Mark Hicken, managing director of Janssen UK, said that the abiraterone decision was long overdue, adding: “The length of time taken to gain approval in the UK demonstrates a clear need for reform of the way Nice appraises innovative cancer medicines. We are concerned that the CDF changes recently approved by Nice and NHS England will only exacerbate these problems.”
Heather Payne, consultant in clinical oncology at University College Hospital, London, said: “I am delighted that abiraterone will now be routinely available on the NHS. Abiraterone has been shown not only to significantly extend life expectancy but is well tolerated.”