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December 2011
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Cancer Commissioning—at a global and a local level: London Cancer New Drugs Group Annual Meeting
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Very rare cancers—the challenge contd.
Dr Griffiths conceded that some of the costs of developing new drugs for rare cancers may be justified, because research investment has to be recouped from a smaller market. Against that, however, should be set the massive savings on marketing, distribution and post-marketing surveillance.
Loading all the costs on to a particular rare cancer is an artificial accounting trick when the drug concerned might have been developed originally with a number of different cancers in mind. Research costs should be aggregated across the whole of a pharmaceutical company’s drug development programme, he argued. “There’s no transparency—all we get is a price. And that puts PCTs at huge financial disadvantage,” he commented.
Dr Griffiths was also highly critical of the concept of exceptionality—a label that is rarely justified. The concept of exceptionality means different things to different people. A PCT looks at the opportunity cost of one patient against another. Government ministers, on the other hand, always have an eye on the tabloid headlines.
“In practice, the numerator is the cost per case or, more realistically, the cost of providing the service for a rare cancer. The denominator is the entire NHS budget—and against that, almost any cost can be made to seem trivial.”
Dr Griffiths argued for greater consistency and transparency across the whole spectrum of specialist commissioning. Indeed, for the next round of commissioning, we should have a set of core ethical principles made explicit in the process.
He concluded, somewhat provocatively: “The more expensive a service is, the closer the number-needed-to-treat (NNT) to show a survival benefit should be to 1. It makes no sense to fund very expensive treatments that work only occasionally or for very few patients. PCTs must have the confidence that they are not just funding a specialist gravy train.”
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Discussion.