Re: Cancer drugs, survival, and ethics
Peter Wise rightly raises ethical concerns about the regulatory approval of high cost cancer drugs with limited survival benefit. . The unsustainable pricing model of newer cancer drugs is causing concern worldwide. .
But Pharmaceutical companies have a fiduciary duty to maximise profits for shareholders in market based economies. It is up to the society to draw the line on cost benefit ratio and for it to be politically feasible, public opinion would play a decisive role.
We surveyed UK public perception on the monetary worth of chemotherapy drugs. The results were presented at the European Society of Medical Oncology annual meeting at Copenhagen in October 2016..
In a face to face survey, members of public were asked "What price do you think it is reasonable for a pharmaceutical company to charge for the chemotherapy drug ?" and were provided various scenarios ranging from a drug with 50% cure rate to a drug with palliative benefit only without any life prolonging benefit.
Surprisingly, only a small minority (11%) were in favour of drug costs in excess of 100,000 pounds even if the drug has got the potential to cure 1 in 5 cancer patients. Of more relevance to the real world setting, only 5% were in favour of drug costs more than 100,000 pounds if a drug does not cure but makes cancer patients live longer by an extra 6 months. 
This UK survey provides strong public support for value based pricing in the NHS..
1 Wise PH. Cancer drugs, survival, and ethics. BMJ 2016;355:i5792. doi:10.1136/bmj.i5792
2 29 S, Kirzinger 2016 | Ashley, Wu B. Kaiser Health Tracking Poll: September 2016. http://kff.org/health-costs/report/kaiser-health-tracking-poll-september... (accessed 20 Nov2016).
3 Sundar S, Johnson HD, Taylor S, et al. Are the newer chemotherapy drugs worth their high cost? - A survey of UK public’s perception of reasonable price for chemotherapy drugs according to their health benefit. Ann Oncol 2016;27:1023P. doi:10.1093/annonc/mdw377.03
4 Raftery J. Value based pricing: can it work? BMJ 2013;347:f5941. doi:10.1136/bmj.f5941
Competing interests: Advisory boards, Conference sponsorship and Clinical trials funding from various Pharmaceutical companies. Past member of NHS England Urology CRG which provided service specifications for area commissioners. Also until recently, a member of NHS England Cancer Drug Fund (CDF) panel which entailed regular voting on drug funding requests.