Access to, cost of, and value of high-price prostate (and other) cancer drugs

As all our regular readers will be well aware, it is not enough, in the UK, for a new cancer drug to be approved for use by the European Union and its European Medicines Agency. In England they also have to be given the green light by the National Institute for Health and Care Excellence (NICE). And NICE’s recommendations carry great weight with other European nations (Scotland, Wales, and Northern Ireland included).

Whether we like it or not, this is, in the end, all about money, and about the financial resources of the National Health Service and its regional groups to be able to cover the costs of all forms of drug therapy needed by a population of 64 million people.

Because NICE was not approving some of the newly available, high-cost cancer drugs, even before 2010, and the British cancer community was up in arms about this, the Conservative Party promised that, if they were elected, they would set up a special fund to pay for such cancer drugs and make them available to those who really seemed to need them (above and beyond whatever NICE had approved). This was a political promise that was kept — for once. In 2010 the current government set up the UK’s Cancer Drugs Fund and the costs related to treatment with > 40 cancer drugs has been paid for out of that fund since 2010. But there’s a problem.

The Cancer Drugs Fund was originally given a budget of £600 million (about US$940 million). It has recently been given an additional £160 million (about US$250 million) to last through March 2016. But the fact is that the Cancer Drugs Fund is way overspent and over budget. As a consequence, the government has stated that, although patients who have been started on drugs being paid for through this fund will be able to continue to get them, some drugs (none of which are for treatment of prostate cancer) are going to be dropped from the list and 10 new drugs (one of them cabazitaxel/Jevtana) are going to be re-evaluated. Thus, it may become impossible for new patients to get treatment with cabazitaxel in the UK at some time in the not too distant future.

Everyone from the National Health Service to NICE to patient groups seems to accept and agree that the current situation is unsustainable, that the Cancer Drugs Fund itself cannot continue to be justified in its present form, and that “something” needs to be done. However, there appears to be no consensus whatsoever on what that “something” needs to be.

The ability of nationalized healthcare systems to justify paying the costs demanded by the global biopharmaceutical industry for certain types of innovative product seems to be getting closer and closer to the endgame. How this will play out is anyone’s guess. What is quite clear, however, is that (a) everything has a price and (b) individuals and organizations are only going to be willing to pay a price that, in their opinion, reflects the value of the good or the service they are considering buying. If we can’t find a sensible way to correlate value to price for healthcare products and services, then we are going to have a big problem on our hands in the near future — and not only in England and the rest of the UK.

5 Responses

  1. I bet you figured I would respond! As it happens, I heard about this early today, in a tweet from the Socialist Health Association. It too said that the Fund should be abolished. Then I found the article that has been causing all the fuss.

  2. George: That’s by no means the only article! have a look around at the other British media today.

  3. That is a good idea. I will, if I have the time. It would be interesting to see the comments.

  4. This explains the present problem. The Cancer Drugs Fund was a quick political fix that has failed.

  5. The price:value or cost:benefit analysis is both fascinating and daunting. It requires an economic value to be placed on patient lives, as well as evaluating longer of shorter working contributions. This is a relatively easy part of the calculation that has been made for decades by actuaries and economist.

    The much harder value:benefit to quantify is the cost of pain and suffering, or relief thereof, and the emotional and family costs. The great Chicago Nobel Laureate Gary Becker, who recently passed, won his prize for figuring how to make such evaluations. I have long thought that my alma mater would be the perfect institution to quantify this conundrum.

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