To be sure, the situation concerning cancer drugs in the United Kingdom is twisted. The government's attitude seems to be that oncology treatments are hugely expensive—and that too much of the National Health Service budget is vanishing into the pockets of drug companies. Yet every time the National Institute for Clinical Excellence (NICE) advises against covering a new oncology treatment, the media cry that local health authorities aren't paying for the drugs cancer patients need. In a BBC survey, 180 oncologists said they were worried that important cancer drugs aren't being funded because NICE has claimed they are not cost-effective.
"For every £100 the National Health Service spends, just £1 is spent on cancer medicines," claims Richard Barker, director general of the Association of the British Pharmaceutical Industry.John Melville, chief executive of Roche UK, agrees. "We spend somewhere on the order of £500 million in total on cancer medicines," he says. "But the debate might be more productive if there were more insight into the decisions we make. This is a question of priority. In France, they spend three times per capita what we do in the United Kingdom. Surely it would be more constructive to look at whether these medicines deliver value. Many countries believe they do, but it's not the case in the United Kingdom. There is little difference in the incidence of cancer, in broad terms, across Europe, but cancer survival is very different."
Research bears this out. A report by scientists from Sweden's Karolinska Institute, published in the journal Annals of Oncology in May, says that both cancer survival rates and uptake of new medicines are far lower in the United Kingdom than in France, Germany, Italy, and Spain. In these countries, more than half of cancer patients are receiving drugs that have been launched since 1985; in the United Kingdom, that figure is just 40 percent.
Figures for some newer EU members are even more revealing. "The uptake in places like the Czech Republic and Hungary is better than in the United Kingdom," says Barker. "You might think that these countries, which are getting their health systems together, would not be able to afford the drugs, but that's not the case."
One way the United Kingdom is trying to improve cancer care is by setting up local cancer networks coordinating those involved in diagnosis and treatment. There are now 30 networks across the country. However, these can lead to further inequalities in treatment, depending on where patients live. "It's important we don't hide behind the generalities," says Melville. "There are cancer networks that deliver care that's second to none, and there are others that do not."
Meanwhile, reports that NICE has been stalling on determining the effectiveness of expensive therapies abound. "There are two types of drugs—those that have been through NICE and those that have not," explains Melville. "Those that have been through the procedure have varied uptake. I can point to some areas where the uptake of Herceptin, which has been approved by NICE, in eligible patients is as low as 20 percent. I don't buy the excuse we often hear of conservatism in UK prescribers. It's very variable. At one end we have those who are on a par with the best of the world, and then those who are most politely described as third world."
Sarah Houlton is Pharmaceutical Executive's global correspondent. She can be reached at [email protected]