To improve cancer outcomes, we need a medicines framework which is fit for the future
Anju Bhalla, Head of Oncology
| Sanofi
Access to innovation is proving increasingly difficult for UK cancer patients. Unpicking the policy barriers is important for achieving the government’s ambitions of improving outcomes. Now is the time for a resolution
This content has been developed and sponsored by Sanofi UK & Ireland.
Since the landslide election victory in July, the Labour government has committed that action will be taken to fix a “broken” NHS. From the perspective of cancer patients, action cannot come soon enough.
Lord Darzi's review highlighted the urgent need to accelerate the adoption of new treatments, tackle waiting times and improve early-stage diagnosis.1 Innovative medicines are helping people live better and longer with cancer, or even become cancer-free. But to get treatments into the hands of patients, it is vital that we have a system that can flex and adapt to keep pace with advances in science.2
The UK is falling behind its European neighbours
It should concern us all that we are falling behind other European countries in terms of access to cancer medicines. Worryingly, England ranks 13th place in the league table, falling from 7th in 2022.3,4 Furthermore, cancer survival rates in the UK are lagging as much as 25 years behind our European counterparts.5
A lack of flexibility in the UK’s medicines evaluation system is proving to be an increasing problem. A growing number of innovations don’t easily fit into processes created for a previous era of medicine. While multi-indication therapies (one medicine licensed to treat several diseases) and combination therapies (which use two or more medicines in combination to treat cancer) offer hope of improved outcomes for cancer patients, it is becoming less and less certain that these innovations will be made available to NHS patients in England. Why?
Inflexibility in the assessment of new treatments is blocking progress in cancer
NHS England currently does not assess the value of a medicine on each indication and/or combination other than in exceptional circumstances.6 This approach disconnects cost from the medicine’s differing value across disease areas. A recent study exploring the health impact of terminated National Institute for Health and Care Excellence (NICE) appraisals for multi-indication medicines revealed that over 9,000 years of life may have been lost for UK cancer patients due to limited treatment availability.7
For combination therapies, the barriers are compounded. In a system designed to evaluate single medicines, getting these treatments into the hands of patients is proving increasingly difficult.
A further recent challenge is a result of the change to NICE methods for evaluating medicines, including the replacement of an ‘end of life modifier’ with a ‘severity modifier’ as part of cost-effectiveness calculations.8 As such, the goalposts have moved for medicines which entered the Cancer Drugs Fund prior to 2022, and are now being re-appraised against different criteria, meaning that patients can find themselves with fewer treatment options.
A medicines framework that is fit for the future
With more than 390,000 people diagnosed with cancer each year in the UK, the government must make bold changes to help improve outcomes.5 The ongoing review of NHS England’s Commercial Framework is one opportunity for positive change. For patients to be assured of long-term access to innovative treatments, its vital we have a medicines framework that is fit for the future.
For further information read our What If? Report: A Vision for the UK as a Life Sciences Superpower.
MAT-XU-2404158 (v1.0) | October 2024
References
1. Professor the Lord Darzi of Denham. Independent Investigation of the National Health Service in England. Available at: https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf [Accessed: October 2024]
2. Access to Oncology Combination Therapies in Europe: Moving Forward. Available at: https://www.efpia.eu/media/e5fljxe2/access-to-oncology-combination-therapies-in-europe-moving-forward.pdf [Accessed: October 2024]
3. European Federation of Pharmaceutical Industries and Associations. EFPIA Patients W.A.I.T. Indicator 2023 Survey. Available: https://efpia.eu/media/vtapbere/efpia-patient-wait-indicator-2024.pdf [Accessed: October 2024]
4. European Federation of Pharmaceutical Industries and Associations. EFPIA Patients W.A.I.T. Indicator 2022 Survey. Available: https://www.efpia.eu/media/s4qf1eqo/efpia_patient_wait_indicator_final_report.pdf [Accessed: October 2024]
5. Macmillan Cancer Support. Decades behind and failing patients, UK cancer care is ‘stuck in the noughties’ Available at: https://www.macmillan.org.uk/healthcare-professionals/news-and-resources/blogs/cancer-care-decades-behind [Accessed: October 2024]
6. NHS. 2022. NHS Commercial Framework for New Medicines. Available at: https://www.england.nhs.uk/wp-content/uploads/2021/02/B1688-nhs-commercial-framework-for-new-medicines-june-22.pdf [Accessed: October 2024]
7. Mitchell, H. et al. 2024. Is the United Kingdom (UK) medicines pricing policy failing patients? The impact of terminated National Institute for Health and Care Excellence (NICE) appraisals for multi-indication products on patients. medRxiv. 08.06.24311489
8. NICE (2022), Public board meeting agenda and papers January 2022 – Technology evaluation methods and processes review. Available at: https://www.nice.org.uk/about/who-we-are/board/public-board-meetings/public-board-meeting-agenda-and-papers--january-2022#technology-evaluation-methods-and-process-review [Accessed: October 2024]
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