New UK Cancer Drugs Fund Moved Forward, As Report Shows UK Lags Behind in Cancer Drug Use

Zosia Chustecka

July 29, 2010

July 29, 2010 — The uptake of new cancer drugs in the United Kingdom lags behind that of many other countries, mostly because reimbursement is refused on grounds of cost-effectiveness. It is an issue that is regularly highlighted in the media, often with emotive case histories of cancer patients who are refused access to potentially life-saving medicines.

In an effort to counter this problem head-on, the new coalition government has set up a new Cancer Drug Fund that will pay for medicines that the National Institute of Clinical Excellence has not allowed for use in the National Health System.

This fund was to start up on April 2011, and was pledged to be worth £200 million, but the start-up date has just been brought forward to October 2010, and an extra £50 million has been allocated to cover the initial 6 months of operation.

The announcement of this new "emergency fund" was made at the launch of a new government report showing the extent to which the uptake of new cancer drugs in the United Kingdom lags behind that of other countries.

Announcing the new funding, Heath Secretary Andrew Lansley said it was a "scandal" that although the United Kingdom is strong in cancer research and participation in clinical trials, many patients with cancer are denied access to new medicines, according to a report in the Pharma Times. "Patients should have access to innovative cancer drugs that can extend or improve their quality of life and which their doctors recommend," he said. "The new funding will help ensure that this happens, and that we meet the goal of cancer patients immediately while we set out longer-term plans to change the way we pay for drugs so that patients get better access to medicines and the [National Health Service] gets better value for money."

UK Near Bottom for Cancer Drug Use

The new report covers many different therapeutic areas, including heart disease and dementia, and in some fields the United Kingdom fares well in comparison with other countries, including 9 other European countries, Australia, Canada, and the United States.

For example, the United Kingdom was ranked second of 14 countries on its use of statins — second only to Australia — and also on its use of thrombolytics in acute myocardial infarction — second only to Denmark. However, it was ranked thirteenth of 14 for drugs used in multiple sclerosis — higher only than New Zealand.

When overall drug use was considered, the United Kingdom was positioned in the middle ground and ranked eighth of 14 countries.

However, on the use of cancer drugs, the United Kingdom came near the bottom. For overall use of cancer drugs, it ranked tenth of 14 countries, beating only Norway, Australia, Canada, and New Zealand. For cancer drugs licensed in the last 5 years, it came in at number 12, with only Canada and New Zealand ranking lower. In addition, usage of cancer drugs lunched within the last 5 years was less than 50% of the all-country average.

However, usage was also low for older cancer drugs — for those licensed between 6 and 10 years ago, the United Kingdom was ranked ninth of 14, and for cancer drugs licensed more than 10 years ago, it was ranked number 10.

The United Kingdom was ranked above average in its use of cancer hormones, however, positioned at number 5 of 14 countries. In the discussion, the report suggests that this greater use of cancer hormones compared with cytotoxics may be related to a cultural "aversion to toxicity."

The report emphasizes that these rankings should be "treated with caution," as there is no judgment as to whether high or low levels of usage are considered to represent good clinical practice.

The report was prepared for the Secretary of State for Health by Mike Richards CBE, MD, FRCP, who is the national director for cancer services and who is often referred to as the "cancer tsar." It combines data provided by IMS Health and manufacturers, together with insights from a range of UK experts.

Speaking at the press launch, Dr. Richards said the report shows a mixed picture of the uptake of drugs across a range of diseases, but he acknowledged that the "usage of new cancer drugs is relatively low in comparison with international averages," according to a report in the Daily Telegraph. However, Dr Richards also pointed out that there are many other factors that play a role in cancer treatment, including surgery and radiotherapy, and he emphasized the importance of early diagnosis. In addition, he said the low usage of cancer medicines is not a significant factor in cancer survival rates, adding, "there is no right or wrong level for each of these drugs."

"I honestly do not think that drug usage is linked to survival," Dr. Richards said, according to a BBC News report. "Early diagnosis remains the most important factor," he added.

Aversion to Toxicity in the United Kingdom?

"Some experts suggested that clinicians in the UK may be more 'toxicity averse' than their counterparts in some other countries, and this may result in them taking a different view of whether the benefits of a drug sufficiently outweigh the risks associated with its use in a particular patient," the government report comments under a discussion of clinical culture.

"In the area of cancer, clinicians suggested that this aversion to toxicity could explain the low usage of some drugs, such as taxanes," it continues. "Usage of taxanes is not restricted by [the National Institute for Clinical Excellence,] but they are perceived to present a higher risk of toxicity than some other forms of treatment.

"Conversely, this may explain the relatively high usage of hormonal treatments...[which] are administered in primary care and are generally seen to be a less toxic form of treatment for some cancer patients," the government report comments. The United Kingdom had the highest use among all 14 countries for tamoxifen, anastrozole, and goserelin.

One surprise that came out of the report was that the use of rituximab (Rituxan; MabThera) and imatanib (Gleevec; Novartis) was not higher, given that both drugs have received strong recommendations from the National Institute for Clinical Excellence and "receive high levels of clinical support." Among the potential explanations put forward is that rituximab is used off-label in other countries, and imatanib is used at a higher dose, especially on progression.

Among the next steps outlined in the report is a plan to examine the interplay between different classes of drugs, including whether the use of cancer hormones affects on the use of other cancer drugs.