While NHS England has added three new medicines to the national Cancer Drugs Fund, experts have urged the Scottish government not to establish such a Fund.
The new products added to England’s Fund are Sanofi/Regeneron’s Zaltrap (aflibercept) in second-line colorectal cancer and two Roche products – Avastin (bevacizumab) in second-line ovarian cancer and Perjeta (pertuzumab) in breast cancer.
These additions have been made following a review of trial data from the drugs by the Chemotherapy Clinical Reference Group (CRG), one of 74 such Groups which provide clinical advice to NHS England regarding a range of specialised services. The Group examined the available evidence regarding the drugs’ efficacy, plus data relating to their safety, and says it is working closely with clinicians and representatives of the pharmaceutical industry to ensure a rapid review process for new drugs that many be appropriate for including on the Fund list.
“These new additions to the list demonstrate NHS England’s commitment to achieving maximum benefit to patients from the £200 million Cancer Drugs Fund,” said Professor Peter Clark, chair of the Chemotherapy CRG. ‘The process of updating the list is led by cancer specialists, and should ensure that patients benefit quickly when new drugs become available that are backed by good evidence from trial data,” he added.
The manufacturers of the three newly-added drugs have agreed a confidential commercial scheme with NHS England.
Last month, NHS England took on responsibility for the operational management of the £200 million-a-year Cancer Drugs Fund. This has created, for the first time, a single national system for deciding which approved fast-track drugs are available to patients and for which conditions, if they are not routinely funded by their local NHS, it says.
However, two experts who have just completed a review of the way the Scottish Medicines Consortium (SMC) assess new medicines have warned that Scotland should not consider setting up such a Fund.
Giving evidence to the Scottish Parliament’s Health and Sport Committee this week, Philip Routledge, professor of clinical pharmacology at Cardiff University, stated that he would be “loathe to single cancer out from other conditions which shorten life or reduce the quality of life.”
Professor Charles Swainson, former medical director at NHS Lothian, agreed, telling the parliamentarians that no evidence had been presented to him for the review to demonstrate that cancer drugs are treated any differently from other drugs in the SMC’s decision-making, “or indeed in the decision-making by Individual Patient Treatment Requests [IPTRs].”
Around two-thirds of IPTRs are successful, both overall and for cancer drugs, he said.
The Committee has been examining general issues regarding the approval process for newly-licensed medicines and the IPTR system, and Prof Routledge told the members that he had concluded from his review that “the process which Scotland uses to appraise new drugs is a very good one, and one which Scotland should be proud of.”
The recommendations made in his report relate largely to trying to increase the transparency of the process so that all those involved “are able to see the qualities of the process that Scotland uses,” he said, while Prof Swainson said many of his recommendations are “about tightening up and improving on what is there already, and essentially asking for more transparency and public reporting.”
The panel discussed the review’s finding that only 74% of drugs approved by the SMC are then included on Scotland’s NHS Board Area Drug and Therapeutic Committees (ADTC) lists. Labour MSP Dr Richard Simpson told the experts: “I believe the public cannot understand that when the SMC recommends a drug for general use or for restricted use, it is not then implemented across the whole of Scotland.”
Dr Swainson said he had “a great deal of sympathy” with this view, and that while his recommendations had not called for just one ADTC, “I think for the introduction of specialist medicines that it would be a very good idea. The gain would be that everyone understood how the drug was to be introduced and patients in Scotland would benefit in a more uniform format,” he said.
Scotland’s NHS spends around 15% of its £12 billion annual budget on prescription drugs, and Health Secretary Alex Neil told the inquiry that drugmakers “could be more forthcoming on the cost of developing a drug.”
Pharmaceutical companies are “very secretive” about pricing, he said, and while he understood that each firm is operating in a competitive commercial environment and they are in business to make a profit, “I would welcome more information on cost.”
“One wonders if we are getting the best bang for our buck,” said Mr Neil.
– As part of its inquiry, the Health Committee will hold an evidence session for patients, clinicians and the industry at the end of this month.
