Cancer Drugs Fund 'papers over cracks', says charity

http://www.bbc.co.uk/news/health-29805717

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A fund to pay for cancer drugs that are not available on the NHS "papers over" deeper drugs pricing issues, according to charity Breakthrough Breast Cancer.

Thousands of women with terminal breast cancer are being denied extra time with their loved ones due to the high cost of new drugs, it said.

The charity called on drugs firms and government to make medicines more accessible.

Drugs firms said more drugs needed NHS approval.

NICE, the National Institute for Health and Care Excellence, said it approved drugs based on clinical and cost effectiveness.

Over the past few years, NICE has not recommended at least seven breast cancer treatments, with cost being a factor in the rejection of over half of those treatments.

Drugs fund

Life-extending drugs that are not available on the NHS can currently be paid for through the £200m per-year Cancer Drugs Fund.

The fund is due to be available until the end of March 2016.

Many drugs have been rejected for approval by NICE on the grounds of cost, Breakthrough Breast Cancer said.

The charity has called for action from the government, the pharmaceutical industry, drugs approval body NICE, and charities to bring down the costs of new treatments and sort out funding issues.

"The Cancer Drugs Fund was only supposed to be a temporary solution and, while it should remain until a workable alternative is found, it is merely papering over the cracks of a system which is no longer fit for purpose," said Chris Askew, chief executive of Breakthrough Breast Cancer.

"Whilst there will be no quick fix solution to this problem, the pharmaceutical industry will need to get serious about its pricing and whoever forms the next government will need to get a grip on the problem and take action to resolve it," he added.

The cost of a life

The NICE drugs approvals process takes into account the cost of the drug, as well as how it effects a patient's quality of life, and how long they live.

NICE uses a measure called a "quality adjusted life year" - a "QALY" - to gauge how much it would cost to give patients a year of healthy life using a treatment.

Drugs that cost up to between £20,000 and £30,000 per QALY can get NICE approval, but end-of-life drugs that cost almost double that can also be approved.

However, some innovative cancer treatments can cost up to £100,000 per QALY, so are dropped by NICE, Breakthrough Breast Cancer senior policy manager Caitlin Palframan said.

"We understand it costs money to develop new treatments," she said. "It's not that we believe that pharmaceutical companies don't have a right to make a profit.

"However, it doesn't do anybody any good if the treatments aren't available on the NHS," she added.

The charity gave the example of breast cancer drug Kadcyla, which is not routinely available in England and Wales, due to its cost.

Safety net?

Cancer drugs that are rejected by NICE can be funded through the Cancer Drugs Fund, but only in England, Ms Palframan said.

In Northern Ireland, Scotland and Wales, terminally-ill patients must get cancer specialists to apply for funding for non-approved treatments.

It was "unacceptable" that some terminally-ill patients "are having to fight for their treatment", she told the BBC.

The high costs of new cancer drugs mainly reflect research costs, drugs industry body the ABPI said.

"The price of development is high," said ABPI director of value and access Paul Catchpole. "It can cost more than £1bn and 10 to 12 years to research and develop a new medicine."

In addition, only one third of new medicines end up covering research and development costs, he said.

"The issue is - who decides what 'high' and 'appropriate' is?" he added.

Mr Catchpole said there were "no upper limits" on what the Cancer Drugs Fund was willing to pay, and called for "evolution" in how NICE assesses cancer drugs.

"We need to make sure [NICE] is taking into account the full costs and benefits of proposals," on the wider economy, he said.

The approvals body said it "makes recommendations for treatments based on the clinical and cost effectiveness of each drug."

"For NICE to recommend a treatment it must work at least as well as, or better than, currently available NHS treatments for the price that the NHS is being asked to pay," it said.

The body said that so far this year it had recommended five cancer treatments, and one drug had been recommended for a specific group of patients.

It has rejected two cancer drugs this year.