Perspectives of commissioners and cancer specialists in prioritising new cancer drugs: impact of the evidence threshold

The provision of high quality cancer services is a major priority for the NHS.1 However, greater budgetary pressures are being placed on specialist hospitals and health authorities by several factors:

• Recent development of several new cancer drugs

• Expanding use of existing drugs

• An ageing population

• Introduction of cancer screening programmes

• Increasing expectations of patients

Christie Hospital NHS Trust in Manchester provides specialist cancer care to a population of 4.5million people from North Wales to Cumbria. The trust's drug budget of £4 million accounted for 18% of the total income from patient services in 1996-7,creating an obvious focus for annual negotiations with commissioning health authorities. Historical underfunding of the trust's drug budget, relative to that of other oncology centres, further supported the trust's case for increased resources. Clinicians highlighted the paradox whereby only 1% of the annual NHS drug budget (£58 million) was allocated to cytotoxic drugs for treating a disease that would affect at least one in three of the population, while £200 million was spent on treating constipation.2^–4

The trust was concerned that individual health authorities within its catchment area would negotiate different contracts, resulting in inequitable access to new developments, as has previously occurred with cancer treatments.5 A Greater Manchester consortium of six health authorities was established, partly as a response to this and partly to develop more efficient commissioning. The consortium, responsible for purchasing around two thirds of services from the hospital, also advised neighbouring health authorities in the catchment area. It soon became clear that the trust's proposed developments could not be met in full from available resources and the consortium agreed to set priorities in funding drug developments. This paper describes our joint experiences in prioritising drug proposals for 1997-8.