Big pharma waits decision on cancer drugs
A scientist prepares protein samples for analysis in a lab at the Institute of Cancer Research in Sutton©Reuters
Tensions are rising between pharmaceutical companies and the UK government, as the industry braces for a decision on which drugs will be axed from a special fund for expensive cancer therapies.
NHS England is due to announce the results of a review of the cost-effectiveness of more than 40 medicines currently paid for by the Cancer Drugs Fund.
The expected decision to cut the number of cancer treatments available to NHS patients in England will intensify debate over access to medicines, as the government battles to close a forecast £30bn health funding gap by 2020-21.
Pharmaceutical companies say patients risk being denied the latest treatment because of financial pressure while critics accuse the industry of overcharging for medicines that offer only marginal benefits over existing products.
These arguments have come to the fore in the increasingly rancorous dispute over the Cancer Drugs Fund, which was set up in 2010 to provide extra funding for medicines deemed too expensive under the usual formula for judging value for money in the NHS.
Many medical professionals and academics object to the fund because it provides special treatment for cancer patients only and because it overrides the recommendations of the National Institute for Health and Care Excellence (Nice), the body that assess the cost-effectiveness of drugs.
This view appears to have been gaining ground in government as the growing cost of the fund has focused ministers’ minds on the budgetary implications of a policy that has been described as a “blank cheque” for cancer drugs.
In August, NHS England announced a 40 per cent increase in the fund’s annual budget to £280m and the government has since admitted it is already on course to “exceed” this increased figure in 2014-15.
In an attempt to bring costs under control, advisers to NHS England met last month to re-evaluate which drugs should be covered, with those demonstrating the weakest cost-effectiveness at risk of exclusion.
NHS England says the changes will put the fund “on a much firmer footing . . . as it faces increasing demand and growing financial pressure” while “encouraging pricing that delivers value for money for patients and the public”.
The Association of the British Pharmaceutical Industry has warned that the measures “threaten to take the UK back to a time of clear rationing of cancer medicines”.
However, big pharma is far from unanimous in its support for the fund, which disproportionately favours companies such as Roche, Johnson & Johnson and Novartis which are strong in cancer drugs.
Stephen Whitehead, chief executive of the ABPI, said the best outcome would be a reformed Nice with more flexibility to recommend expensive cancer medicines.
Nice judges medicines based on their cost per “quality-adjusted life year” (QALY) — a formula designed to measure the price of a drug versus the health benefit it delivers. The institute has generally considered £30,000-per-QALY as its upper threshold for cost-effectiveness.
This is far below the price of some of the most advanced cancer drugs.
One high-profile example is Roche’s Kadcyla breast cancer medicine, which was shown in clinical trials to extend life by an average six months compared with existing treatments, at a list price of £90,000 per patient.
The drug was rejected by Nice last August but is available through the Cancer Drugs Fund.
Critics say the ability for companies to sell their cancer medicines through the fund in spite of rejection by Nice meant there was no pressure to cut prices until the recent overhaul. Kadcyla is among the 40 products under review by NHS England.
The Cancer Drugs Fund is due to expire in 2016 but Labour last month said it would set up its own version if it wins the general election in May — demonstrating the public pressure on all parties to fund treatment for cancer.