Commissioning Cancer Drugs and Services: Shared Strategies For A Common Goal

There are many challenges still to be faced, marginal benefit, patient and public pressure, the issue of co-payment and increased scrutiny in response to higher profile, to mention but a few. Generally though, NECDAG is proving both effective and credible. There is no reason why such a group cannot be set up elsewhere; however, a regional approach is essential. Those considering this approach should also bear in mind certain caveats—while NECDAG has improved equity of access to cancer drugs within the North East, for example, regional postcode prescribing remains an issue because of differences in prescribing elsewhere in the country.

Of course, NECDAG along with similar groups countrywide would not be necessary if NICE were more timely—the recommendation of the Cancer Reform Strategy and the Department of Health Select Committee that NICE review all drugs in line with licensing approval is the ultimate goal.

Prioritisation in London and Herts

Provided by Alastair Whitington, Network Director, SE London Cancer Network, London

The role of NICE is to ensure that all patients have access to clinically appropriate and cost effective treatments. Once recommendations are made, they are expected to be implemented; however, the process of gathering and reviewing evidence takes an average of 18 months and, in the event of appeals, final guidance may take up to 3 years to be published.

In the absence of NICE guidance, it is for the PCT to determine whether or not to fund a drug for their population. This process has historically been managed through applications for non-NICE approved drugs being referred for consideration by PCT panels for funding as Exceptional Treatment Authorisations (ETAs). With each PCT operating independently and varying degrees of expertise in the gathering and assessment of available information, inconsistencies of approach inevitably arose, resulting in postcode prescribing.

An LCNDG analysis of London expenditure on new cancer drugs showed a 430% increase in overall investment in new NICE approved cancer drugs over the past 7 years. In addition, over the past 4 years, there has been a significant increase in expenditure on non-NICE approved drugs, suggesting a rise in the number of ETA requests and an associated increased potential risk of individual PCTs funding drugs, which have little clinical benefit.

An analysis of the prioritisation and approval process for non-NICE approved drugs in the five London and Mount Vernon cancer Networks (the LCNDG sponsors) revealed a variety of approaches, although all inevitably featured a significant reliance upon the ETA process.

Every year, Network management teams used to facilitate a horizon scanning exercise. They assessed new non-NICE approved drugs and looked at changes in indications of existing drugs based upon LCNDG recommendations and local knowledge. The aim? To determine which drugs are likely to impact upon the Network over the next financial year.

 

Page 6 of 8

Previous Page Next Page

---