What might the current Westminster Government mean for ... - BOPA

What might the
Westminster
Government
mean for
access to new
cancer drugs?
With the coalition Government in place in Westminster, Mark Evans, Bethan Tranter and
Mary Maclean set out some of the potential implications for access to new cancer drugs
in England, Wales and Scotland respectively
England
Central to the assessment of new high
cost medicines in England is NICE.
The coalition Government’s programme
contains a pledge to reform NICE.
In the absence of substantive detail,
the effect of this on access to high
cost cancer medicines remains largely
speculative.
Making NICE more independent of
Government would certainly be in line
with other coalition health policies,
such as a reduction in ‘top down’
reorganisation and the establishment
of a new independent NHS health
board. The Government has also said it
intends to move to value based pricing,
where the price paid for a drug is
determined by its health benefits. That
this is mooted in the context of NICE
reform suggests that NICE may play
a key role in this strategy. Indeed,
the assessments required to establish
value-based pricing, such as the
determination of cost effectiveness, are
already largely undertaken by NICE.
With the acceptance of patient access
schemes in its health technologies and
the introduction of the patient access
scheme liaison unit, NICE has already
gone someway towards value-based
pricing. An independent NICE with a
responsibility to determine value based
pricing does not therefore seem to be a
vision incompatible with Governmental
thinking.
The programme for Government
also sets out the establishment (by April
2011) of a £200million fund to enable
patients to access the cancer drugs
‘their doctors think will help them’. This
includes medicines that have been
turned down previously by NICE and
so how this fund will work without
undermining the NICE process is not
yet clear. Moreover, a fund equating
to roughly £400,000 per 100,000
population might soon be exhausted
by the breadth of expensive anti-cancer
medicines on the market, and therefore
prioritisation and assessment will be
necessary. Perhaps a more effective and
pragmatic solution would be to amend
the NICE framework to account for the
added perceived value of life extending
anticancer medicines. Such work has
already begun, with the introduction of
NICE’s end of life criteria (in January
2009) which have facilitated access
to drugs such as sunitinib (for renal
cell carcinoma) and lenalidomide (for
myeloma).
Increasing spending on the NHS in
real terms each year of the Westminster
parliament is among the conservative
party pledges that have been agreed
in the ‘programme for Government’.
However, in an environment of
continually increasing demands on
the NHS, investment in new high
cost drugs is going to be heavily
dependant on making efficiency
savings. This is very much the mantra
of the new secretary of state for Health
for England, Andrew Lansley, who
stresses that the NHS will have to go
even further than the planned annual
efficiency savings, approximating to
£20billion by 2013/14, set out by
the previous labour Government. These
levels of efficiency savings can surely
only be realised with quite significant
restructuring of the NHS. The effects of
this restructuring (such as the scrapping
of strategic health authorities by 2012)
on regional decision making groups
and processes for new cancer drugs
remains to be seen.
Wales
With Wales following NICE guidance,
any changes to NICE and its remit
have the potential to impact on access
BOPA Bulletin Issue 1 Summer 2010