NHS cancer patients in the UK are missing out on innovative treatments available in countries of comparable wealth partly because of a failure by medicines regulators to negotiate with the pharmaceutical industry on the price of drugs, the Breast Cancer Now and Prostate Cancer UK charities have said. The report, published by the two charities compared the availability of treatments in England, Scotland and Wales with that in Germany, France, Australia, Canada and Sweden.
Nice (the National Institute for Health and Care Excellence) in England and Wales, and the SMC (Scottish Medicines Consortium), decide not only the clinical value of a drug but also its cost-effectiveness. However, the latter decision is based solely on the price quoted by the manufacturer, whereas in other health systems one public body makes clinical recommendations and then it is left to another to negotiate to the best of its ability.
Sally Greenbrook, policy manager at Breast Cancer Now, said: “What we found happening elsewhere is one organisation like Nice is doing the analysis of clinical excellence and quality of life, length of life and giving it a quality rating and that feeds into a negotiation process. When we consider the benefits of a drug, we should consider the clinical benefits and not how much it costs at that stage. That should then inform what we’re willing to pay for it. If we have a bit more flexibility in the negotiation scheme, we can perhaps see some of these drugs made available.” Nice has not approved a single new breast cancer drug for routine use in the NHS in the last seven years, while just two treatments have been approved by the SMC in that time. “We know cancer outcomes are worse than in some other countries in Europe and part of that is going to be access to treatment,” said Greenbrook.
One of the drugs highlighted is Kadcyla, which can offer women living with incurable secondary breast cancer an average of an extra six months of life. It was launched two-and-a-half years ago and is now available in Germany, Canada and France. However it is only available through application to the Cancer Drugs Fund (CDF) in England, and is not available at all in Scotland or Wales. The value of the CDF as a fallback is diminishing however as it has been reformed because of concerns over its finances and can no longer prescribe drugs not approved by Nice. It will limit what the CDF can approve in future and is likely to see drugs withdrawn from the fund.