Sir Andrew Dillon, chief executive of the National Institute for Health and Care Excellence, has questioned the stark misalignment between decisions made by the cost watchdog and those of England’s Cancer Drugs Fund.  

“The problem with the CDF for NICE is that there is now misalignment between the standard approach that we take to our ambition and willingness to pay, and, in effect, the ambition and willingness to pay as expressed through the CDF,” he told a Health Select Committee hearing on Tuesday.

When quizzed by MPs, Sir Andrew side-stepped the question of whether the CDF should be merged with NICE’s work, but did say that the processes should be aligned. 

“I would like to move away from the situation in which…the CDF has said yes to the treatments we have said no to”, he said.

Take Roche’s Kadcyla (trastuzumab emtansine), for example. NICE rejected the drug last month to treat women with aggressive breast cancer, because its incremental cost came in at a whopping £160,000 per QALY, thereby falling well outside of the range of what is normally considered value for money for the NHS (£20,000-£30,000 per QALY). But the drug can be accessed through the CDF.

“I don’t think that makes any sense. It’s not a criticism of the decision to allocate more money to cancer. It’s about an alignment of processes and methodologies that we need to get sorted out”, Sir Andrew told MPs, adding that there is “no reason why [NICE] couldn’t provide the basis for NHS England’s cancer decisions as we do for all the other treatments we look at”.

Looking forward, the government recently put out a call to NHS England, NICE, patient organisations and industry groups to join together in looking at a new way of managing the entry of cancer treatments onto the NHS. 

Welcoming the move, Sir Andrew noted that there are lots of interesting opportunities for an approach that would ensure “the treatments we feel should be available to patients are available to patients” and, secondly, “that we realign the approach we are taking with cancer treatments with whatever ambition the NHS ultimately turns out to have”.

NICE consultation

The Committee also heard that a NICE board meeting has been set for September 17 at which proposals for updating NICE methodologies - in particular relating to value-based assessment - will be discussed, following a public consultation earlier this year.

The proposals seek to incorporate two new “value elements” - burden of illness and wider societal impact - into NICE appraisals. 

If approved without the need for extra work then the new system could be implemented immediately, Sir Andrew told the hearing. This, however, seems somewhat unlikely, as it was also noted that, while the consultation had had a fantastic response, there was a huge range of opinion and that disagreement was in several different directions.