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July 2010
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Cancer Commissioning—at a global and a local level: London Cancer New Drugs Group Annual Meeting
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End-of-life care—the anomalies
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Professor Christopher McCabe (Director of the Academic Unit of Health Economics, University of Leeds) said that although many patients at the end of life might not choose chemotherapy just for a survival benefit of 3 months, they would if it improved quality of life (QoL). In one study, it was revealed that the median survival threshold for accepting chemotherapy was 4.5 months for mild toxicity and 9 months for severe toxicity.
He said that the NICE end of life premium raised many concerns:
- Where is the evidence to support the argument that members of the general public value life-extending treatments at the end-of-life more highly than other interventions?
- Why should we value health gain differentially for people with a relatively rare cancer?
- Why are QoL-improving therapies excluded from the NICE end of life premium?
For the pharmaceutical companies, there is now an incentive to prioritise small, rare cancer populations when bringing new drugs to market—and to subcategorise common malignancies as rare cancers with a shared clinical presentation. The process impaired the ability of the NHS to negotiate lower drug prices on the basis of value for money, and would divert resources away from preventive and chronic health care.
“As things stand, new cancer drugs and end-of-life technologies have a distinct advantage compared with other models of cancer care,” said Professor McCabe. Whether that advantage will be maintained in the glare of clinical evidence has yet to be established.
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Discussion.