Commissioning Cancer Drugs and Services

The London Cancer New Drugs Group

“The LCNDG aims to facilitate consistency of approach in London by informing the managed entry of new drugs in cancer treatments and to promote the cost-effective and equitable provision of all medicines used in cancer management.”

Initially set up as a sub-committee of the London Cancer Networks Steering Group to manage the entry of imatinib into the NHS, the LCNDG has evolved into an independent body of professionals with the responsibility of developing recommendations for the managed and uniform entry of new treatments across London. Making the decisions are individuals from the five networks in London plus Bedfordshire and Hertfordshire, representing acute services, public health and commissioners, with specialist support from regional Medicines Information. Observers from Scotland, Northern Ireland and Wales are also welcomed to the meetings.

The group’s recommendations, which are not mandatory, are published at http://www.nelm.nhs.uk and are designed to help PCTs reach decisions on the use of new cancer drugs until such a time as NICE guidance becomes available. The premise is that the lack of NICE guidance cannot be used to prevent prescribing of a drug. Guidance is, importantly, also developed for treatments that are unlikely to be reviewed by NICE and occasionally to provide clarification when NICE guidance is particularly complicated.

While recommendations from the LCNDG are welcome, how widely they are implemented, if at all, was a subject of debate among those at the meeting. The importance of implementing a mechanism for assessment of uptake should not be underestimated. Only through collaboration between PCTs and cancer networks can a systematic response to the managed entry of new drugs across London—and indeed nationwide—be realised. The question remains, however, is the LCNDG model appropriate as the number of new cancer treatments escalates?

There was also a call from the floor for more effort to be made by the LCNDG and similar bodies to provide cost-effectiveness analysis. Once identified for review by the LCNDG, the relative effectiveness of a treatment is assessed, taking into account its effect on survival and quality of life, the strength of the evidence supporting its use and ethical considerations. The likely impact of a drug’s use on resources is also, however, of interest. Indeed, cost-benefit and opportunity-cost calculations are becoming increasingly important within the appraisal process, be it that of the LCNDG, NICE, the SMC or the AWMSG.

According to the Office of Health Economics, between 1992 and 2006, expenditure on prescribing in England trebled to more than £9 billion. While this figure is staggering, it is noteworthy that only an estimated 6% of this total was spent on cancer. Nevertheless, when discussing numbers in excess of £500 million, the forecast global tripling of the cancer drug market by 2010—in part as a result of the predicted launch of molecular therapies—is a huge concern. Indeed, one of the greatest challenges facing cancer services over the next few years is how to manage the entry of new drugs into the NHS without bankrupting the system. This and other challenges facing cancer services are discussed in more detail below.

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