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From a cancer drug fund to value based pricing of drugs

BMJ 2010; 341 doi: (Published 12 August 2010) Cite this as: BMJ 2010;341:c4388
  1. Martin Duerden, assistant medical director (primary care)
  1. 1Betsi Cadwaladr University Health Board, Matthew House, Llys Edmund Prys, St Asaph, Denbighshire LL17 0JA
  1. martin.duerden{at}

    Such pricing may be hard to implement and may not add value

    In late May 2010, the National Institute for Health and Clinical Excellence (NICE) decided not to support sorafenib (Nexavar) for use in hepatocellular cancer in England and Wales. NICE advised that the drug was not cost effective; it costs around £27 000 (€32 400; $42 500) for each course of treatment and improves median survival by 2.8 months in people dying of cancer (50% of people might be expected not to get this benefit, and 50% might get this benefit or more).1 The media response was mostly an outcry, “Fury as new cancer drug is banned.”2

    Various patient groups and experts were also not happy with this decision. Professor Karol Sikora representing CancerPartnersUK said, “It is devastating that NICE has failed to use this opportunity to properly consider the very strong recommendations from UK oncologists who only want the best for their patients.”3 It is noteworthy that none of these emotive responses suggested or recognised that the drug may cost too much in relation to its limited benefit and that this money might be better spent elsewhere in the NHS—for example, on palliative care services, where arguably it might give better value for money.

    NICE’s most favourable analysis of the incremental cost per quality adjusted life year (QALY) for sorafenib versus best supportive care was £52 000, even with the drug company reducing the cost paid by the NHS by 25% as part of a patient access scheme.1 Even using controversial “end of life” criteria, …

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