Arguing that cancer patients in the United Kingdom are missing out on new treatments, two leading charities are calling for the government to conduct direct price negotiations with drug makers and push for flexible pricing based on patient outcomes.
In making their case, Breast Cancer Now and Prostate Cancer UK funded a report that found cancer patients in some countries of comparable wealth — such as Germany, France, Australia, Canada, and Sweden — generally have quicker access to cancer medicines. As a result, the charities maintain the approach taken in the UK to measure clinical effectiveness and cost effectiveness should change.
Specifically, the charities suggest the National Institute for Health and Care Excellence, or NICE, in England and Wales, and the Scottish Medicines Consortium should not decide both the clinical value of a drug and its cost effectiveness. The report, which was released on Monday, noted that in other countries, one public entity generally makes clinical recommendations while another negotiates with companies.
The report comes amid escalating tensions in many countries over the cost of prescription medicines. Cancer treatments, however, are a particular flashpoint in the UK, where a government-sponsored Cancer Drugs Fund is in decline over its finances. The fund can no longer prescribe medicines not approved by the UK’s NICE, and there is concern that some drugs may not be covered in the future.
“Leaving patients with this uncertainty is unacceptable. And that’s why action is needed to enable industry to negotiate new pricing models, and to give more weight to patient evidence so that the next generation of new cancer treatments reaches those in need,” Heather Blake, director of support and influencing at Prostate Cancer UK, said in a statement.
As an example of the quandary, the report pointed to the Kadcyla breast cancer treatment, which was launched more than two years ago and is available in Germany, Canada, and France. But in the UK, the medicine is only available through the Cancer Drugs Fund in England, but not available at all in Scotland or Wales.
The report notes that NICE has not approved a new breast cancer treatment in seven years, while the SMC approved only two medicines during that time. Earlier this year, several UK charities estimated that as many as 22,000 cancer patients could lack access to treatments annually as a result of the changes at the Cancer Drugs Fund.
When it comes to access to medicines, NICE is a hot potato.
The agency is routinely skewered by both patient charities and drug makers for denying coverage recommendations based on cost effectiveness. Last month, Eisai threatened NICE with legal action after the agency delayed making a recommendation for its thyroid cancer drug until at least April 2017. The European Commission approved the treatment in May 2015.
“The NICE evaluation program hasn’t kept pace with innovation and relies too much on a basic cost-effectiveness threshold for assessing value for money and which remains unchanged in over 15 years,” said Paul Catchpole, director of value and access at the Association of British Pharmaceutical Industries, in a statement.
“We are seeing scenarios where some new medicines used in combination with established treatments would be rejected by NICE even if they were given away free due to the fact that patients are taking them for longer,” he said. “Only when we see a fundamental shift away from medicines being used as a cost-containment exercise, rather than part of a sustainable National Health Service, will we begin to improve services for patients.”
The pharmaceutical industry does not agree with the charities, however, about price negotiations.
“To suggest that the problem is just down to an inability to negotiate with pharmaceutical companies is too simplistic,” Catchpole continued. Drug makers already negotiate prices, an apparent allusion to a few instances in which companies have agreed to peg the cost to performance. But he conceded there is “room for more creative approaches,” without offering specifics.
As for NICE, Andrew Dillon, who heads the agency, sent a statement saying “the cost of new drugs has to be justified by the benefits they bring to patients or other NHS services will lose out… (companies) need to go further to help us to enable access to the most expensive new medicines.
“International comparisons are interesting but they need to be viewed in the context of what those countries are actually paying for the drugs and whether the health system pays the whole cost, like the NHS, or whether, as in some countries, patients have to make a contribution too.
“NICE doesn’t make decisions about which new drugs to recommend for use in the NHS in isolation. We look to NHS England and the Department of Health to set the ambition for access to cancer medicines and then we support them in achieving their goals with the recommendations we make.”