{"id":50,"date":"2014-08-29T17:15:54","date_gmt":"2014-08-29T16:15:54","guid":{"rendered":"https:\/\/blogs.ncl.ac.uk\/oncpall\/?p=50"},"modified":"2014-08-29T15:13:28","modified_gmt":"2014-08-29T14:13:28","slug":"no-more-mr-nice-guy-can-we-continue-to-afford-new-cancer-medicines","status":"publish","type":"post","link":"https:\/\/blogs.ncl.ac.uk\/oncpall\/2014\/08\/29\/no-more-mr-nice-guy-can-we-continue-to-afford-new-cancer-medicines\/","title":{"rendered":"No more Mr NICE guy\u2026 Can we continue to afford new cancer medicines?"},"content":{"rendered":"

By Steve Williamson, Consultant Cancer Pharmacist, National CDF Panel Member and Module Leader.<\/em><\/strong><\/p>\n

My Module, Cancer Drugs and Technologies <\/a>looks at pricing and market access to cancer medicines amongst other things.\u00a0 This is an area that is never far from the news headlines. Last week saw the announcement of changes to the Cancer Drug Fund (CDF), which provides funding for high cost cancer medicines for patients in England.\u00a0 The fund which was \u00a3200million has been increased to \u00a3280million for this year and next\u2026 just as well, as the fund overspent last year by nearly \u00a350Million.\u00a0 It also highlighted some important changes to the ways the CDF will work, more of that later.<\/p>\n

The CDF was seen as the great solution to accessing high cost cancer medicines, extra money specifically to fund drugs too expensive for the UK\u2019s\u00a0 Health Technology Assessment body, NICE.\u00a0 It\u2019s fair to say that the CDF has worked and improved access and its first three years and funded many new treatments that get turned down by NICE.\u00a0 But one of the great weakness of the CDF is it hasn\u2019t taken account of cost, until now.\u00a0 You can speculate that this has led to manufacturers being less concerned at keeping their UK pricing down as the CDF will fund it anyway.\u00a0 Look at the row between Roche and the NHS over its new breast cancer drug, Kadcyla.\u00a0 See the coverage on the BBC http:\/\/www.bbc.co.uk\/news\/health-28688311<\/a>.\u00a0 In summary, NICE have said no and patients are disappointed, NICE were not able to agree an acceptable discount with Roche, but the drug is available at full price on the CDF.<\/p>\n

NICE said they were unable to say yes as the company were not working with them on pricing. Their chief executive Sir Andrew Dillon said: “We are really disappointed that Roche were not able to demonstrate more flexibility\u2026The company is well aware that we could not have recommended Kadcyla at the price it proposed.\u201d This is really strong language for NICE who usually do not comment when they say no.\u00a0 Roche then went on the counter offensive with Roche Senior figures quoted: “We’re very disappointed with this decision and, frankly, not just for patients\u201d, “NICE’s rejection of Kadcyla demonstrates quite simply that their current system is broken, not fit for purpose\u201d, strong words.<\/p>\n

Now it just happens that this row was between NICE and Roche, but in truth given the global pricing trends it could have been any manufacturer with a new expensive cancer drug.<\/p>\n

But what are the facts behind the headlines?\u00a0 Kadcyla, is new version of an existing drug trastuzumab (herceptin) that offers benefit after patients disease has progressed on trastuzumab.\u00a0 It is the original trastuzumab molecule a biological targeted agent combined with a traditional cytotoxic agent, which is then \u2018delivered\u2019 directly to the tumour, clever stuff.<\/p>\n

But Kadcyla is not a curative drug, its used (for the moment) in patients with advanced breast cancer.\u00a0 The trials show it extends median overall survival by 6 months, that is patients will on average live 6 months longer.\u00a0 Its costs \u00a390,000 for a 14.5 months course of treatment, equivalent to \u00a375,000 a year.\u00a0 This compares to trastuzumab at \u00a321,000 per year.\u00a0 So why is it so much more expensive than the original molecule?\u00a0 The Pharmaceutical industry often quotes drugs development costs to justify high prices, but have development costs increased so much in 10 years?.\u00a0 Development costs are often driven by need to test many molecules that don\u2019t prove to be successful in search for a winner.\u00a0 In this case you could argue that there were none of these costs as the drug combined existing drugs. Only Roche have answers to this. My view is that it is overpriced and the high price is driven by recent high prices in other cancer drugs, it seems that as soon as the next \u2019most expensive\u2019 cancer drug price is accepted, this resets the pricing benchmark and prices just keep spiralling higher.<\/p>\n

So coming back to the CDF (still with me?) you could speculate that manufacturers will be less keen to try and seek agreement on discount price with NICE if the can have their drug funded in England by the Cancer Drug Fund.\u00a0 The NICE rejection has not hurt Roche\u2019s sales in England as the CDF continues to pay the full price, reaching agreement with NICE could be seen as counter intuitive for Roche as soon as NICE say yes at a discount the CDF will stop paying full price.\u00a0\u00a0 The CDF panel has recognised this and part of the changes announced recently mean that they will look more closely at prices of drugs it has approved and will be trying to support NICE in its efforts to encourage more realistic pricing for the UK.\u00a0 There is going to be some interesting discussion at the next CDF panel meeting, that\u2019s for sure!<\/p>\n

 <\/p>\n

All\u00a0opinions expressed in our Blog are those of the author and not of\u00a0Newcastle University.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

By Steve Williamson, Consultant Cancer Pharmacist, National CDF Panel Member and Module Leader. My Module, Cancer Drugs and Technologies looks at pricing and market access to cancer medicines amongst other things.\u00a0 This is an area that is never far from the news headlines. Last week saw the announcement of changes to the Cancer Drug Fund … Continue reading No more Mr NICE guy\u2026 Can we continue to afford new cancer medicines?<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":5463,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10,11],"tags":[],"class_list":["post-50","post","type-post","status-publish","format-standard","hentry","category-cancer-drugs-fund","category-pharma"],"_links":{"self":[{"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/posts\/50","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/users\/5463"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/comments?post=50"}],"version-history":[{"count":5,"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/posts\/50\/revisions"}],"predecessor-version":[{"id":55,"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/posts\/50\/revisions\/55"}],"wp:attachment":[{"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/media?parent=50"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/categories?post=50"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.ncl.ac.uk\/oncpall\/wp-json\/wp\/v2\/tags?post=50"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}