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Press Releases
Panorama: Access to cancer drugs should not depend on where
patients live, says NICE chief
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The Chief Executive of National Institute for Health and
Clinical Excellence (NICE), Andrew Dillon, has weighed into
the debate about expensive cancer drugs that have not been
approved by NICE, saying access to them should not depend on
where patients live.
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Dillion has called for a consistent approach from Primary
Care Trusts (PCTs) when they consider whether to make funds
available for medicines that have already been judged by NICE
not to be cost-effective for the NHS.
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He tells the 91Èȱ¬'s Panorama programme: "What patients need to
do... is to find out from those who are making the decision
what the basis of that decision is, and if they don't think
it's reasonable, if they don't think it compares
appropriately with decisions that are taken elsewhere, ask
why not."
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The Government has promised to speed up access to new drugs
on the NHS and end the apparent unfairness of people being
able to get medicines in some areas when they can't do in
others.
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But how easy will that be to deliver?
With NHS resources stretched, the health watchdog NICE will
increasingly be forced to make decisions that patients and
doctors find hard to take and locally PCT judgements on
drug funding will continue to mean a string of winners and
losers.
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Naomi Kiely was diagnosed with bowel cancer four years ago,
aged just 30. Having responded well at first to chemotherapy,
she recently discovered that the cancer has returned
aggressively – an even more bitter blow as she's planning to
get married next month.
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However, she took heart from her
consultant who told her about Avastin – a new drug she could
try with fewer side effects.
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Naomi was informed: "It won't affect your hair. You'll have
the same quality of life and you will be a healthy person
living with cancer who's getting chemo treatment but it's so
targeted that it will only target the tumours. It won't
target any of the good stuff in your body so you'll be able
to get married, you'll be able to feel well."
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But there is a problem. Although Avastin has been licensed as
an effective treatment for bowel cancer, it has not been
approved for NHS use by NICE.
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NICE uses a complicated calculation to work out whether a
drug is worth paying for. Basically the cost is weighed up
against the benefit it is likely to bring and the result is
called a Quality Adjusted Life Year (QALY).
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Because Avastin
prolongs life by an average of just four months, its cost per
QALY works out very high, at between £40,000 and £70,000.
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That is well above the £30,000 value-for-money benchmark NICE
normally sets for new NHS drugs.
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Once a national decision has been taken that a drug is not
cost effective, that is not necessarily the end of the story.
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Doctors can still apply on behalf of individual patients for
exceptional funding from local health boards or PCTs.
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But
this process is fuelling the postcode lottery the Government
says it wants to get rid of.
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Naomi Kiely's consultant, Mark Saunders, became so concerned
by these inequalities that he decided to analyse the
exceptional funding decisions taken in north-west England
over two years on three expensive cancer drugs.
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Among the
PCTs that send patients to his unit, he has found the average
approval rate pretty high at 75%.
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He says: "If you have a patient from Cheshire they have a very good
record. Most of the time we apply to Cheshire they tend to
fund patients that have exceptional circumstances. If we
apply to the Manchester Primary Care Trust then in the eight
applications we've made they've only accepted one for funding
in 2006."
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Unfortunately for Naomi Kiely, she comes under Manchester PCT
and her application has been turned down for funding.
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She was "horrified" by this decision: "When you need the
NHS more than ever they're saying no, sorry you're in the
wrong postcode. I thought are the PCT playing god? How poorly
do I have to become for them to say actually we will give her
this drug." Ìý
In the programme, Andrew Dillon also hints that NICE may not
be able to meet Health Secretary Alan Johnson's recent
pledge to try to bring decision-making on new drugs down from
an average length of two years to just three months.
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Mr Dillon was questioned about why it has taken NICE two-and-a-half years, without yet reaching a decision, to deliberate
over the drug Lucentis.
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Many older people suffering from the eye condition Wet Age-
related Macular Degeneration (Wet AMD) have been losing their
sight as PCTs across England have chosen not to fund the
treatment until NICE reaches a decision on Lucentis.
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Professor Jonathan Gibson, consultant ophthalmologist at
Birmingham Eye Hospital, says Lucentis could save people
suffering from Wet AMD.
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"Lucentis is a major breakthrough
because for the first time we have a drug that not only stops
the process and prevents the vision getting worse but in a
substantial proportion of cases actually improves the
vision."
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Yet in Scotland, where the Scottish Medicines Consortium
(SMC) decides which drugs should be available on the NHS to
Scottish patients, a decision was taken to approve Lucentis
in just three months and patients have routinely been
receiving the drug for over a year.
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Mr Dillon points out that, unlike the SMC, the NICE process
involves public consultation and a formal appeals procedure
which can slow down decision-making.
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On the issue of Lucentis, he told Panorama: "There may have
been some things that possibly we could have done more
rapidly and we may looking back, wanted to have started work
on that particular topic earlier than we did. But we would
always have taken longer than the position in Scotland."
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Notes to Editors
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Please note in any copy: This edition of Panorama, The NHS Postcode Lottery - It Could Be You, will be
broadcast on 91Èȱ¬ÌýOne on Monday 18 August 2008 from 8.30 to
9.00pm.
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PH
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