Thousands of NHS patients in the UK are missing out on access to innovative treatments that are available to patients living in some other countries of comparable wealth, finds new research by charities Breast Cancer Now and Prostate Cancer UK.
According to their report, ‘International Comparisons of Health Technology Assessment’, a key reason for the UK’s poor performance on access is the rigidity of the its appraisal systems, in that they lack the opportunity for negotiation on drug prices.
The report reviewed the drug systems and the availability of breast and prostate cancer treatments in England, Scotland and Wales compared to five similar countries: Germany, France, Australia, Canada and Sweden.
It shows for example that Roche’s Kadcyla (trastuzumab-emtansine) – a drug that can offer women living with incurable secondary breast cancer an extra six months of life on average launched two and half years ago – is available in Germany, Canada and France, but can only be accessed by patients in England throughout the Cancer Drugs Fund and not at all in Scotland and Wales.
Looking at global health technology assessment bodies, the research also highlights that, in many cases, they play a key role in access but are only one part of a wider process, and notes the opportunity for assessment of peer systems to gauge whether any elements could be applied to improve access to cancer drugs for NHS patients.
The charities are now calling on the Secretary of State for Health to review the current role of the National Institute for Health and Care Excellence, as well as work on renegotiating the current arrangements for the Pharmaceutical Pricing Regulation Scheme (PPRS) in time for 2018, “so that price negotiation can be brought into the system, enabling patients to access the best available treatments at prices that the NHS can afford”.
“This report demonstrates the need for serious reform of the way our health system assesses, and determines the availability of, the cancer drugs that patients rely upon,” said Baroness Delyth Morgan, Chief Executive at Breast Cancer Now.
“Pharmaceutical companies must indeed start offering more responsible prices. But until our health bodies are empowered to negotiate the price of cancer drugs, patients in the UK will continue to miss out on new treatments being offered elsewhere”.
However, commenting on the report, Dr Paul Catchpole, Director Value and Access at the Association of the British Pharmaceutical Industry, said it is “too simplistic” to suggest that the problem is just down to an inability to negotiate with pharmaceutical companies.
ABPI response
“Companies engage in pricing negotiations with the NHS but without doubt there is room for more creative approaches. This is despite the UK already having some of the lowest prices for medicines among similar economies and a deal which has seen companies pay back over £1.3 billion pounds to the Government in the last 18 months to help keep NHS spending on medicines affordable”.
He went on to say that the concerns of the cancer charities “are real”, and that “the NICE evaluation program hasn’t kept pace with innovation and relies too much on a basic cost effectiveness threshold for assessing value for money and which remains unchanged in over 15 years”.
“With cancer medicines now more effective than ever in extending life, we are seeing scenarios where some new medicines used in combination with established treatments would be rejected by NICE even if they were given away free due to the fact that patients are taking them for longer. The bottom line is that the system we have in the UK for assessing medicines needs to further evolve”.
“Only when we see a fundamental shift away from medicines being used as a cost containment exercise rather than part of a sustainable NHS will we begin to improve services for patients. If we want to improve survival rates for our patients we should be prepared to invest more, not less,” he argues.
