Perceptions of value – the cancer drugs fund debate

In the next response from Let’s talk cancer, Jamie Hayes takes a look at the cancer drugs fund debate.

Click on Wales has been publishing a series of responses to the discussions and ideas that occurred as part of Let’s talk cancer. The IWA’s Let’s talk cancer project crowdsourced ideas to improve cancer care in Wales between June and July 2015. Over 6 weeks patients and their carers posted their idea for how to make things better for those affected by cancer in Wales. In all we had around 100 ideas submitted. We’ve taken these ideas to a panel of practitioners who have given their responses to the 12 ideas we shortlisted using voting on the website. Today, Jamie Hayes considers the cancer drugs fund debate.

Cancer Fund for Wales, suggested by Jean H

Wales needs a cancer drug  fund and more patient involvement.

Another vote for a drugs fund in Wales, suggested by BettySpaghetti

The WG must stop trotting out the line that a cancer drugs fund would discriminate against those with non-cancer conditions. Take the word cancer out of the title and let’s have a fund that makes a wider range of drugs available if that really is the issue.

Welsh patients are left with a stark choice: give up or move to England, thus losing your GP/Macmillan nurse and entitlement to benefits after SSP runs out due to owning property you are no longer able to live in.

Practitioner response:

Jamie Hayes, Director of the Welsh Medicines Resource Centre within the All Wales Therapeutics and Toxicology Centre. He is also an Honorary Senior Lecturer in the School of Medicine, Cardiff University:

The debate about the merits of a cancer drug fund for Wales has been well rehearsed between healthcare professionals, patients,  media and politicians since the Cancer Drugs Fund came into existence in 2010. It’s worth noting that the fund was originally introduced in England as a temporary measure in response to proposed developments for the introduction of value based pricing of drugs.

Successive Welsh Ministers have made it clear that the Welsh Government rejects the notion of a Cancer Drugs Fund for Wales. The Minister for Health and Social Services, Mark Drakeford, has informed AMs that “the right way was is a system in the Welsh NHS that is fair to all patients, is clinically driven and provides good outcomes at a cost effective price”. The First Minister, Carwyn Jones highlighted the inequity of the cancer drugs fund when he asked,  “If we say that cancer should be treated as a special case, what then of the people who have had strokes, or heart disease, or multiple sclerosis, or rheumatoid arthritis?”

 There is limited published research looking at the impact of ring-fencing a budget for cancer drugs. In 2014 a team of researchers from Bristol published the results of their research looking at the uptake of cost-effective cancer drugs, the differences between England and Wales and the impact of the cancer drugs fund. They concluded that the fund did not speed up access to new cost effective cancer agents prior to approval by NICE and that the fund resulted in access to drugs deemed not cost-effective by NICE. The same author, in a letter to the British Medical Journal, reiterates this by asking where is the evidence? Evidence that the English public value cancer above other serious or life threatening diseases or evidence that cancer drugs will prolong cancer survival more than comparable cancer treatments such as radiotherapy or surgery. In a frequently cited study, researchers from Bangor University published details of a survey conducted in 4118 adults which looked at societal views on NICE, Cancer Drugs Fund and Value Based Pricing. They found that the concept of a cancer drug fund was not supported, commenting that policies introduced on the basis of perceived, rather than actual societal values may lead to inappropriate resource allocation decisions with the potential for significant population health and economic consequences.

Would a cancer drugs fund be beneficial to patients? Does Wales need its own cancer drugs fund? Let us know your thoughts.

Jamie Hayes is Director of the Welsh Medicines Resource Centre within the All Wales Therapeutics and Toxicology Centre and an Honorary Senior Lecturer in the School of Medicine, Cardiff University

2 thoughts on “Perceptions of value – the cancer drugs fund debate

  1. The problem with this debate is that the English Conservatives are more interested on using individual cases, that may be exceptional, as a stick to beat both Wales and Labour.

    Spending large amounts of money on treatments, judged by NICE to be poorly effective or poor value for money, may be hard on those fighting for a few months of life but what if development of a cure is put back by months or years by bowing to the purchase of such expensive drugs?

    We’re not talking a few quid here, it is in terms of millions. Imagine what researchers could do with that!

    Only recently research has shown that we can manipulate the epigeneome and thereby develop treatments for a wide range of illnesses including many cancers. Which should we spend money on?

    Sometimes we have to be cruel to be kind.

  2. Gwyn, The NHS in both England and Wales is spending a large amount of money on a service that has no peer reviewed evidence of clinical efficacy and that could and should be funded (like Macmillan Cancer Care) by a charitable trust. In Wales this is £1.3 million per annum … which would fund quite a few nurses or, if you insist, a pre-NICE approval drug fund. Which service is this? The Hospital Chaplaincy Service which provides 97.4% of that £1.3 million for Christian clerics to minister to Christian patient (though they will chat to you if you are not Christian and don’t believe a word of their world-view). The Welsh Government has no statutory obligation to fund this service so why do they insist on doing so? The only possible explanations are 1) They fear the reaction of Christian voters (but they faced that down with the organ donation by presumed consent change) or 2) they fear upsetting UNITE.(The impressively named College of Health Care Chaplains is, in fact, just a branch of UNITE the union).

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