At the start of December, the UK government announced a new UK-US pharmaceutical deal. As part of the deal the government committed to increasing the cost-effectiveness threshold for new medicines for the first time in 20 years – allowing the NHS in England to pay more for treatments.
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In this blog, we’ll look at what this means for people living with incurable secondary breast cancer. And whether it will translate into improved access to new and effective treatments that can give them more time to live.
The cost-effectiveness threshold: What is it and what’s changed?
In England, the organisation that decides whether drugs can be made available on the NHS is the National Institute for Health and Care Excellence, usually known as NICE.
To make decisions on the cost effectiveness of a new drug, NICE uses the health economics concept of the ‘QALY’ or quality-adjusted life year. This takes into account the number of years a treatment could be expected to add to a person’s life, as well as the quality of that life.
The NHS sets a standard amount of money they’ll pay for each additional QALY a treatment offers. This ‘cost effectiveness threshold’ is currently £20,000- £30,000 per QALY. The threshold hasn’t risen in over 20 years, but from April 2026 it will rise to £25,000 – to £35,000 per QALY.
Will this mean improved access to secondary breast cancer treatments?
Our #MoreTimeToLive campaign has been demanding action to make sure people living with incurable secondary breast cancer can access the treatments they need to stay alive.
We’ve been calling for the government to spend more on drugs for secondary breast cancer and to make changes to the wider system that’s used to decide how much the NHS will pay for different treatments.
This has included highlighting the need for the cost effectiveness threshold to be reviewed, which was one of the longer-term reforms we called for in our report, “Setting the bar too high”.
The changes to the cost effectiveness threshold are welcome. And we hope it will be a step that could see more people getting access to vital life extending drugs.
However, the real test will be to see if secondary breast cancer drugs like Enhertu, which was rejected by NICE on grounds of cost-effectiveness last year, can now be approved.
What happens now?
We’re ready to work with the government, NICE and the drug companies to make sure this change gives secondary breast cancer patients access to the life-extending treatments they need and deserve.
We’ve written to the Health Secretary, Wes Streeting, NICE and drug companies AstraZeneca and Daiichi Sankyo. We want to understand what the increase in the thresholds will mean in practice and to find out whether Enhertu for HER2-low secondary breast cancer will be resubmitted for appraisal.
We’re also writing to relevant ministers and working with other charities to find out what the impact of the changes will be in the devolved nations.
What’s next?
We’ve been working with Clive Jones and other MPs to bring this issue to parliament.
We’ll soon be able to share the date and details of a debate on secondary breast cancer. The debate will be an opportunity for MPs to discuss access to treatments and other issues affecting people living with secondary breast cancer.
Once the date of the debate is confirmed, we’ll need your help to make sure as many MPs as possible attend – so keep an eye out for more information soon.
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