A new report by leading charities Breast Cancer Now and Prostate Cancer UK shows NHS cancer patients in the UK are missing out on innovative treatments being made available in some comparable countries of similar wealth. The report shows this is likely in part because our appraisal systems lack the opportunity to negotiate on the price of drugs.
The 'International Comparisons of Health Technology Assessment' report – published today – reviewed the drug systems and the availability of breast and prostate cancer treatments in England, Scotland and Wales compared to five similar countries: Germany, France, Australia, Canada and Sweden.
It shows for example that Kadcyla – a drug that can offer women living with incurable secondary breast cancer an extra six months of life on average – was launched two and half years ago and is now available in Germany, Canada and France. However it is only available through the Cancer Drugs Fund in England, and is not available at all in Scotland or Wales.
The comparative report looked at the roles of ‘Health Technology Assessment’ (HTA) bodies – such as the National Institute for Health and Care Excellence (NICE) in England and Wales and the Scottish Medicines Consortium (SMC) in Scotland – in assessing which new drugs are made routinely available.
The research highlights that, while no country is perfect, there are elements of other health systems which could be assessed to see if there is potential for reforms that could improve access to cancer drugs for NHS patients.
In the non-UK countries covered by the report, there is a split between two bodies - the HTA body that assesses the clinical effectiveness of a drug does not also decide whether it is cost-effective. This is very different to the system in England, Wales and Scotland, where NICE and the SMC respectively do both these tasks, but do not have any flexibility to negotiate with industry on price.
In these other countries, one HTA body makes clinical recommendations that then inform negotiations between government bodies and pharmaceutical companies.
NICE, in England, and the SMC, in Scotland, have responsibility for both functions. Some cancers, such as prostate cancer, have seen industry overturn negative rulings by offering patient access schemes (which ultimately amount to a reduction in price). Though even then two treatments for prostate cancer remain in appraisal processes that consist of repeated rejections and appeals. For breast cancer, NICE has not approved a single new breast cancer drug for routine use on the NHS in the last seven years, while just two treatments have been approved by the SMC in that time.
With the Cancer Drugs Fund (CDF) having changed in July 2016, both charities are concerned that access to new medicines in England may only get worse. The new Fund will put its assessment of new drugs in England entirely back into the hands of NICE, whose repeated rejections of new cancer treatments was what the previous CDF was set up to address.
Breast Cancer Now and Prostate Cancer UK are now calling on the Secretary of State for Health to review the current role of NICE, alongside activity to renegotiate the Pharmaceutical Pricing Regulation Scheme in time for 2018, so that price negotiation can be brought into the system, enabling patients to access the best available treatments at prices that the NHS can afford.
Breast Cancer Now and Prostate Cancer UK are calling for:
1. Consideration of how more flexibility could be brought into the system to allow price negotiation, as happens in other countries. To find agreements that work for all:
- drug prices could, for example, be increased or decreased after launch based on follow-up data from trials
- different prices could be allowed for different indications of the same drug, as is the case in France – known as ‘multi-indication pricing’
- current methodologies should be reviewed so that they are able to respond effectively to the new generation of treatments that are on the horizon.
2. Countries in the UK to review their respective systems to ensure that the HTA process (as undertaken by NICE and the SMC) plays a key role but isn’t the whole system
- in other countries, HTA plays a role but is only one part of a wider process.
3. Reform to the way drugs are assessed to ensure that it takes account of the patients’ views of the full benefits of new drugs
- although UK systems have the most robust patient engagement, this is not leading to patient access
- currently benefits are assessed based on a small sample of measures, ignoring crucial aspects like level of fatigue (a common symptom of prostate cancer)
- NICE does not explain how it takes account of patient views in its decisions
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said:
“That NHS patients are being denied access to innovative new breast cancer drugs, while other countries are finding ways to make them available, is totally unacceptable.
“This report demonstrates the need for serious reform of the way our health system assesses, and determines the availability of, the cancer drugs that patients rely upon.
“Pharmaceutical companies must indeed start offering more responsible prices. But until our health bodies are empowered to negotiate the price of cancer drugs, patients in the UK will continue to miss out on new treatments being offered elsewhere.
“Unfortunately the new CDF will not provide the change required to see the best new breast cancer drugs start gaining approval in England, and patients just cannot wait any longer. We desperately need the Secretary of State for Health to restructure the system to allow price negotiation and ensure that NHS cancer treatment does not fall any further behind the rest of the world.”
Heather Blake, Director of Support and Influencing at Prostate Cancer UK, said:
“Making all new cancer treatments available to patients is of course made challenging by finite NHS budgets that are stretched to capacity and running at a deficit. But men cannot continue to spend years fighting for access to every new prostate cancer treatment. They need a more streamlined system for assessing and appraising cancer drugs which makes the right decisions first time around.
“Although last month’s CDF reforms aim to address this issue, they place all the responsibility for patient access to new and innovative treatments on the pharmaceutical industry’s willingness to lower its prices meaning that cancer patients once again have the potential to be left in limbo.
“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.”