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April 13, 2010.
The availability of anti-cancer treatments acquired new prominence on the UK political agenda in the ‘phoney war’ before the announcement earlier this month of a general election in May. The leading economic affairs figure in the opposition Conservative party, George Osborne, came out with a promise to fund new cancer medicines - provoking, as a consequence, a heated debate across the nation on drug budgets.
Osborne said that if his party came to power, he would allocate £1 billion so that doctors could use novel oncology treatments that are not currently approved for use in the UK National Health Service (NHS). In typical dog-eat-dog political manner, he was tapping into a rich seam of public discontent in the UK about cancer patients being denied life-saving treatments because of the mean-spirited approach of the body that advises on which medicines may be prescribed, the National Institute for Health and Clinical Excellence (NICE). The attack was calculated to win sympathy with voters and to demonstrate the parsimony of the ruling Labour government.
The plan - which envisaged allowing £200 million a year over the five-year life of a government - was to fund the extra spending by imposing - if the Conservatives were in government - lower employment taxes on the national health service than Labour was threatening. The idea was that patients would be allowed to benefit from kidney and bowel cancer treatments such as Genentech/Roche's Avastin (bevacizumab) and breast cancer therapies such as GlaxoSmithKline's Tyverb (lapatinib).
The strategy was not altogether successful. Osborne was immediately accused of spending money that does not, at present, exist. A leading health think tank, the King's Fund, attacked the proposal as “sleight of hand,” claiming that the funding would have to come out of the current budget. “That means stopping doing something else for other people.” Andy Burnham, the country's senior health minister, leapt to counter-attack, arguing that the promise was unravelling within days of its announcement, and denouncing it as “a shallow attempt to grab headlines rather than tackle the real issue.”
Irrespective of the merits of the positions taken by the protagonists, the debate itself was a valuable illumination, in the public arena, of the battles that pharmaceutical company executives are fighting every day. Companies that develop new medicines know they face a fight to win reimbursement (or, in the UK, approval for use in the NHS), precisely because resources are limited. They know, too, that the general level of information is very low about where medicines come from and how much they cost to develop (and therefore to reimburse). And they know that the decisions made by national authorities over what to reimburse are taken in a maelstrom of conflicting pressures - financial, political, cultural...
This was only a brief high-profile exchange in the UK over what should be reimbursed, and how those medicines should be paid for. The arguments were rapidly overtaken by the announcement of the election date and the outbreak of many much wider electoral battles. But at a time when national authorities everywhere are becoming more careful about healthcare spending, it is important for the medicines industry that it keeps alive the debate about how choices are made, and what factors have to be kept in mind in making those choices.
Just around the corner, as health budgets become even more stringently monitored, health technology assessment is waiting to pounce. Every country in Europe is doing these assessments its own way, often without any clarity or transparency on what criteria they use and what factors they take into consideration. If medicines are to obtain a fair share of healthcare spending, they need to be able to demonstrate they can bring savings as well as costs to healthcare systems. And they will be able to do that only if health technology assessments are conducted in a rational manner. Debates such as the UK anti-cancer treatment spat can help to push these issues into the spotlight. The drug industry should maximise the leverage to get its case across for better-quality decision-making on reimbursement, everywhere in Europe.