Of the 10,797 requests made during that period to the fund, which provides
£200m a year for local health authorities to purchase cancer drugs that have
not been recommended by the UK’s National
Institute for Health and Clinical Excellence
(NICE), 24.8 per cent (about 2,677) were for Avastin (bevacizumab) in
several types of cancer.
Merck KGaA’s Erbitux (cetuximab) and Janssen’s Zytiga (abiraterone) came
second and third respectively, with 11.9 per cent (about 1,284) and 11.8 per
cent (about 1,274) of total requests.
However, this looks set to change following NICE’s recommendation for Zytiga in the
treatment of advanced prostate cancer, meaning the drug is available for
mainstream NHS use.
Completing the top five most requested drugs were Roche’s MabThera
(rituximab), which had 5.3 per cent of all requests (about 572) and
GlaxoSmithKline’s Tyverb (lapatinib), which had 5.2 per cent of all requests
The ten most commonly used drugs accounted for 80 per cent of the total
number of applications.
Most requested drugs using
cancer drugs fund
cancer drug fund applications
Avastin (Roche - bevacizumab)
Erbitux (Merck KGaA - cetuximab)
Zytiga (Janssen - abiraterone)
MabThera (Roche - rituximab)
Tyverb (GSK - lapatinib)
Afinitor (Novartis - everolimus)
Nexavar (Bayer - sorafenib)
Levact (Astellas - bendamustine)
Faslodex (AstraZeneca - fulvestrant)
Halaven (Eisai - eribulin)
Elsewhere in its bulletin, the first
since the launch of the cancer drugs fund in April, 2011, NCAT acknowledged
concerns regarding regional variations in the number of applications made to
This was picked up by the UK Department of Health, which
published a breakdown of applications by strategic health authority (SHA).
During April 2011 to May 2012, the SHA with the most funding requests was
NHS West Midlands with 1,658, while the NHS North East had the fewest number of
requests with 696.
“By publishing this data, patients can see how the Fund is being used in
their area and across the country,” said care services minister Paul Burstow.
These regional concerns were also mentioned in the Rarer Cancers Foundation
(RCF) report on
the cancer drugs fund, which claimed that once population size has been
adjusted for, NHS South East Coast had an approval rate over 50 per cent higher
than that in NHS North West.
“The reasons for this require further exploration but suggest that
significant variations in access existed prior to the cancer drugs fund,” said
The RCF also highlighted the need to take action before the Fund is set to
close in March 2014, three months a new value-based pricing drug reimbursement
system is due to take effect in the UK.
“We estimate that the result of this change would be to deny over 16,000
cancer patients life-extending treatment every year. Over the course of the
next Parliament (expected to be 2015-2020), this would mean that over 80,000
patients could be denied clinically effective cancer treatments,” the RCF said.
Recommendations suggested by the RCF to overcome such issues include a
mechanism to enable treatments currently reimbursed through the Cancer Drugs
Fund to be appraised as part of value-based pricing (VBP), with the discussions
on how this would work in practice to begin by early 2013.
If such a process is not in place by early 2013, the Fund should be
maintained as a transitional measure so as to ensure continuity of access,
according to the RCF.
Such concerns follow comments from Roche in June, 2012, when the pharma company called for
the Department of Health to quicken the process towards pricing negotiations or
patients would miss out.
Since then, the DH and the Association of the British Pharmaceutical
Industry (ABPI) have confirmed the drug pricing
negotiations will begin next month.
As part of these negotiations, the possibility of using a new VBP assessment
on drugs currently funded through the cancer drugs fund will be assessed as per
OF course with our politicalized health-care system, scientific,
based review of treatments and drugs in contrary to the spirit of free
enterprise. Free to do
harm for the sake
of the dollar.
NICE’s International Footprint
NICE International is a little known arm of the UK health technology
assessment (HTA) body, the National Institute for Health and Clinical
Excellence (NICE), but its varied collaborations across
Europe and into emerging markets have given it a global reach.
Set up in 2008 NICE International has grown from founding member Kalipso
Chalkidou to a team of five working within the cost-effectiveness body’s
offices in London’s Holborn. Run as a not-for-profit organisation it is,
nevertheless, income-generating to ensure costs are recouped and do not eat
into either National Health Service (NHS) or NICE funds.
It was established in response to a growing number of overseas requests from
policy makers, academics and practitioners who wanted to know more about the
way NICE works, on both a technical and a strategic level.
“We genuinely think there’s something in what we do that can help decision
makers in other countries that are faced with very similar questions, even
though the setting might be different,” explains Chalkidou.
As well as offering the ‘NICE way’ to other countries, NICE International
actively looks for areas where it can learn from what other countries are
doing, particularly when so many health reforms are being planned and enacted.
But primarily its role is to take its thinking and approach to HTA and clinical
guidelines to other countries.
“There’s a lot of demand out there,” Chalkidou notes, and points to NICE’s
website, which, although intended for a UK audience, nevertheless gets half of
its traffic from abroad.
One strand of NICE International’s work is to provide fast-track training for a
Ministry of Health or national insurance agency. This focuses on critically
evaluating and appraising evidence, looking at economic analyses and how they
could critically review industry submissions.
NICE International is also involved with partners, reviewing the available
evidence for a drug or condition and then adapting it for the local setting.
Naturally, there is also a lot of interest in the activity for which NICE is
perhaps best known, its approach to technology assessments, with countries
outside the UK wanting to learn from NICE how to assess new medicines. But
there is also demand for advice on how countries can build HTA capacity and
make sure they get the right data sets and choose the right efficacy measures.
“People are interested in what others are doing,” says Chalkidou, pointing
to the growing number of HTA networks as evidence of this appetite. In Europe
this takes the form of EUnetHTA, of which NICE itself is a member. Earlier in
2012, the network was championed by European Commissioner for health and
consumer policy John Dalli as a potential way to ease the region’s financial
crisis. “Sharing safety, effectiveness and costs analyses will help health
managers and politicians make better informed choices,” he said.
This process is being replicated outside the EU with, as Chalkidou points
out, networks like HTAsiaLink, which involves Thailand,
Taiwan, China and North and South Korea and also has links with Japan.
The main focus of NICE International has been on flagship projects in countries
like China and Brazil, but it has also been reasonably active in Europe,
working with Albania, Estonia, Romania, Serbia and
“What Turkey has achieved, for instance, with much less funding, in
universal coverage and offering primary care services to its very rural
population, is really wonderful,” Chalkidou enthuses.
There are two common aspects of NICE International’s work in Europe –
clinical guideline standards and technologies. “People are interested in the
standards for practice for professionals – ‘How do we know we’re getting
quality? What does good practice look like when it comes to people with
diabetes?’, for example.”
On the subject of whether or not countries should look to build a relationship
with the pharmaceutical industry, Chalkidou is emphatic.
“We’re very much for engaging with industry, and our advice to our partners
in other countries is to engage in a controlled and managed space and wait, but
engage with industry rather than go ahead and make decisions without involving
She acknowledges that a lot of the organisations or countries NICE
International works with have “a jaundiced view of industry” because of past or
current experiences, but she says NICE International is “very much for engaging
with people who promote products”.
She concludes: “What would really be worth doing, and would be a comparative
advantage for those companies that do it well and do it first, is to gain the
trust of the decision makers.”
Kalipso Chalkidou is the founder member of NICE
International. She holds a PhD in molecular biology from Newcastle, UK, and
spent almost five years working in NICE’s methods division before travelling to
the US for a year at Baltimore’s Johns Hopkins hospital. She was interviewed by
Dominic Tyer, managing editor of PME and PMLiVE.