Cancer Commissioning—at a global and a local level: London Cancer New Drugs Group Annual Meeting

A pharmaceutical industry perspective

Dr Paul Catchpole (Healthcare Management Director, Roche Products Ltd) reported that, based on the limited experience thus far, PASs do appear to be improving patients’ access to innovative drugs, allowing manufacturers to give greater value for money to the NHS while protecting their list prices.

PASLU’s role as gatekeeper would be vital, he emphasised. It would evaluate schemes in a manner that is transparently equitable, with the opportunity of adding further value via feedback to all the stakeholders involved—clinicians, patients, cancer service providers and drug manufacturers. However, without some form of standardisation, there was always the danger that interested parties would be faced with a plethora of different schemes, adding to the cumulative administrative burden.

There was a conundrum in that many new cancer drugs have the potential to be used in multiple tumour indications, whereas NICE has to initiate an appraisal not simply for each drug, but for each drug and for every indication for which its use was proposed. Cost-effectiveness will depend on the indication, so different degrees of commercial consideration are necessary for patient access for the same drug. However, it is not feasible to have 10 different PASs for one drug—a dilemma the Department of Health, NICE, PASLU and the pharmaceutical industry will have to address. The possibility of blended incremental cost-effective ratios (ICERs) had been explored, said Mr Catchpole—as yet, to no avail.

There was emerging evidence, said Dr Catchpole, that patients are willing to pay more for extended life. However, an unintended consequence of the NICE end-of-life criteria was that it favours small populations of patients with rare cancers against the larger populations with common cancers.

Finally, Dr Catchpole argued that efficient local commissioning—whether second-guessing NICE decisions or undertaking independent local evaluations—should minimise the need for independent funding reviews (IFRs). Selection criteria would be essential to avoid duplication of effort, given that the number of local collaborative groups undertaking new cancer drug assessments is growing day by day. It would also be important to establish robust evaluation criteria, making a case for each drug and each indication on the basis of clinical, economic or affordability grounds, unmet need, innovation—or, indeed, a combination of any or all of these factors.

More was said about PASs in the discussion.

Page 6 of 16

Previous Page Next Page

---