From a cancer drug fund to value based pricing of drugs

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4388 (Published 12 August 2010) Cite this as: BMJ 2010;341:c4388

Should NICE or the Daily Mail decide on cancer drugs funding?

The question is raised again as to whether populist decisions made by
politicians (who will inevitably have an eye to the electorate's fickle
feelings and the headline writers of the Daily Mail) are the best people
to prioritise and allocate funds, funds which will never be sufficient to
satisfy all demands.

The figures speak for themselves--a drug which may prolong a life for
literally a few weeks, or the salary of a specialist nurse for a year. Of
course we could prefer not to have to choose, but we do. NICE appraisal
seems the least worst way of doing it. Replacing NICE won't create the
extra resources needed to give everyone everything they want, people like
Karol Sikora must know this.

The last Prime Minister but one, Anthony Blair, made breast cancer a
priority saying that his mother had suffered from it. Now David Cameron
has been elected Prime Minister-by the skin of his teeth-after, amongst
other things, promising to make cancer drugs available to all. Very Santa
Claus of him, but I prefer to trust the impartial and systematic
deliberations of NICE rather than the gut feelings of vote seekers
informed by focus groups.

There are some promising but costly new drugs in the pipeline for
metastatic melanoma, as we have heard on the national news again this
week, no doubt the drug companies are doing their best to place the
stories with the media. Of course I hope the drugs will work and be
affordable, but decisions to fund them at the £30,000 for an extra
3 months of life level we are hearing about should be systematically and
unemotionally weighed against the QUALYs that could be gained by earlier
detection by training primary care workers better in diagnosis. And indeed
against non cancer priorities.

We should remember Dennis Burkitt's tap turner-offers and floor wiper-uppers. The floor wipers are doing a great job, but it would do more good and be
cheaper if someone turned off the tap. The floor wipers are feted and
drive Rolls Royces, the tap turners are ignored and ride bicycles.

Competing interests:
teacher of dermoscopy to GPs

Competing interests: No competing interests

27 August 2010
Stephen F Hayes
GP, GPwSI dermatology
66A Porstmouth road, Woolston, Southampton, SO19 9AL