Centralised cost-effectiveness standards used by the National Institute for Health and Care Excellence and similar appraisals in other countries are limiting patients’ access to new cancer treatments, a new US study claims.

The study, which is sponsored by the Pharmaceutical Research and Manufacturers of America (PhRMA), reports that NICE rejected all six cancer medicines that it reviewed in 2013. It also finds that, during 2007-2013: 

- NICE was more than three times more likely to reject cancer medicines than non-oncology treatments; 

- it rejected nearly 60% of oncology medicines, compared to only 16% of non-oncology products; 

- almost 80% of cancer medicines reviewed by NICE in the period have been given some kind of access restriction; and

- NICE agreed 56% of the time with the decisions of several major countries’ health technology assessment (HTA) organisations for oncology reviews, and 81% for non-oncology reviews.

“The degree of variability of these decisions, especially for cancer medicines, illustrates the complexity of the environment our innovator companies must navigate in order to deliver life-saving medicines,” said PhRMA chief executive John Castellani. “The fact that the same body of high-quality evidence can elicit such different decisions reveals the subjective nature of these assessments.”

Commenting on the study to Pharma Times, NICE pointed out that companies “make huge investments and take considerable risks to bring new drugs to patients. They then list them, and sometimes discount them, at the highest price that the market will bear in order to make the biggest return on their investment.”

“NICE gets all the information it can about how well a drug works, talks to anyone who has an opinion on how the NHS should use them and then applies a standard test for value for money to help the NHS spread its resources as fairly as possible across everything we expect it to do for us,” said a spokesperson.

“But we go further for cancer drugs by being prepared to accept a premium above what we would usually accept for drugs in other diseases and conditions. And even when NICE recommends against the routine use of a cancer drug, the NHS in England makes it available anyway, through the Cancer Drugs Fund,” they added.

NICE also told Pharma Times that “drug companies have a responsibility to patients and to health systems as they decide what the market will bear for their products. As NICE develops our new methods for valuing drugs, we will take the greatest care not to disadvantage patients living with cancer. But we will also remember all those living with the other diseases and conditions that the NHS has to find the money to treat.”

Commenting on the US study, the Association of the British Pharmaceutical Industry (ABPI) said: "cancer medicines have struggled to get through the NICE appraisal system, and the Cancer Dugs Fund was set up to deal with this as an interim solution."

"The global recognition of the problem, highlighted in PhRMA's paper, provides an opportunity for the UK to show alignment with international counterparts to drive a solution."