In the leaders' debate, David Cameron used an anecdote to highlight his cancer drug policy. But his policy would push up drug prices and reduce value for money.
The Conservatives are very keen for the public to believe that billions of pounds can be saved from budgets such as the NHS by eliminating waste. But some of their more populist health policies run counter to this plan.
“I have a man in my constituency called Clive Stone who had kidney cancer who came to see me with seven others. Tragically, two of them have died because they couldn’t get the drug Sutent that they wanted, that was on the market, that people knew was a good drug. That’s a scandal in our country today.”
Setting aside the fact that Sutent does not save lives it prolongs them by a handful of pain free and thus valuable months there are a number of problems here.
First, Sutent has been approved by the National Institute of Clinical Excellence (NICE) for renal cell carcinoma (kidney cancer) since March 2009. NICE has been criticized for being slow to approve new cancer drugs but they have been speeding up the process with an aim to approve within four months. Contrary to many mendacious reports NICE has approved most of the cancer drugs where it has received an application.
Second, there is the question of whether limited money spent on cancer drugs might be better spent elsewhere – on prevention, screening, or retaining staff. NICE bases its judgement on the notion of QALYs (quality adjusted life years) a metric that tries to capture both the quantity and quality of life for each pound spent. Typically NICE approves treatments that cost £20,000 to £30,000 per QALY. However on occasion and especially in the case of cancer patients this figure is exceeded. Sutent was approved based on a QALY estimate of £54,366. It is hard to argue that cancer patients have been hard done by – at least compared to other NHS patients.
Finally, however, this QALY figure does not tell the whole story about Sutent. The initial estimate of QALY cost was actually £71,462. Undoubtedly realising that Sutent would never be approved at this cost, the manufacturers agreed to make the first-cycle of drug treatment free to the NHS – bringing the cost down to the lower QALY figure (£54,366). This is not a lone example. For instance, the manufacturers of glatiramer acetate for treating multiple sclerosis have agreed to reimburse the NHS costs should the treatment prove less cost effective than expected, while the NHS only pays the cost of bortezomib, a treatment for multiple myeloma when patients respond favorably to the drug. Across the board NICE serves to push down the cost to the NHS of expensive drugs. Andrew Dillon, NICE chief executive, said:
“when it appears that the institute cannot support coverage of a treatment given its current price, “we encourage companies to think about what they might do [to make their product cost-effective]… We push the envelope just as much as we possibly can.”
The Conservatives have promised that they will fund the cost of new cancer drugs using £200 million saved from higher National Insurance costs (while perversely discounting the loss of revenues raised by higher NI). However, by undermining NICE and evidence-based medicine in favour of simplistic populism they are likely to find that the cost of these drugs will be far more than they think. Drug companies will not be so generous in future if the Conservatives write them a blank cheque.
A crucial part of Cameron’s quite was missing but has now been added: “That’s a scandal in our country today.”