As the Government in England develops its plans for value-based assessment, a new way of deciding which new drugs it’s willing to pay for and how much it’s willing to pay, we look at what this could mean for men with prostate cancer and ask, what does value mean when it comes to your health?
Over the past few years we’ve seen some real breakthroughs in drug treatments for prostate cancer, with new drugs such as abiraterone, enzalutamide and cabazitaxel all offering the chance of extra months of life.
But getting these new drugs into the hands of men can be a long, complicated process and can be very expensive. From identifying molecules in the lab through to clinical trials in men, drug development costs a lot of money. The Association of the British Pharmaceutical Industry (ABPI) estimates it costs a massive £1.2 billion to develop a single new medicine.
From Autumn 2014, when new drugs come onto the market, they’ll go through a process called value-based assessment, which involves setting prices based on the perceived value of a drug rather than its actual cost.
This could be a dramatic improvement to the current system. But, how exactly is the government going to decide what drugs they will fund and how much they’ll pay for them? And what ‘values’ will this be based on?
Well, unfortunately at the moment, very little is definite. But from what we know, the government wants the price of a drug to reflect its value both to individuals and to wider society. This means they’ll take into account things like someone’s quality of life with, and without, treatment – including the impact of any side effects. But they’re also considering how to weigh up the cost of a treatment against the cost of illness to society as a whole, like the cost of people being unable to work. This can add up to a lot. To give you an idea, the total cost of cancer in the EU, including productivity losses (due to premature death, and people being unable to work), and time spent by friends and relatives caring for loved ones, was recently calculated at €126 billion a year. That’s billion not million.
So the main question that we want to see addressed is: what does value mean, and who gets to decide what’s ‘valued’? We’re concerned about what they’ll term ‘societal value’; for example, will it only be about the economic impact of people not working while they’re sick? If so, what does this mean when assessing drugs for people who are past working age? Will there still be a ‘societal value’ to treating the condition?
We’re working with the National Institute of Health and Care Excellence (NICE) to ensure that this issue is dealt with, and that the needs of people who are retired or won’t return to work after treatment aren’t overlooked. We want men’s voices to be heard, especially about what the value of medicines means to them. As one of our volunteers Stuart Watson, who has prostate cancer, says, “How can you put a price on having your life extended even for a few months, or on getting relief from dreadful side effects? These are things that we patients value, but really are beyond price.”
Other groups, such as Breakthrough Breast Cancer are pushing for similar results. In fact, over 80 patient organisations, including us, make up a group called Patients Involved in NICE (PIN), a united front to give patients a louder voice in healthcare decisions. PIN is chaired by Drew Lindon, our Head of Policy and Campaigns, who can see the potential benefits of the new system but also the need to get it right. He says, “Value-based assessment gives us an opportunity to rethink the system, and make sure that the ‘right’ drugs, those that benefit
people the most, are always made available on the NHS. The work that we’re doing as part of PIN and NICE, to make this happen, is hugely important.”
The high cost of developing cancer drugs means that price may always be an issue. The NHS has a finite budget. It spends about £2,000 per person per year on healthcare costs.
Now compare that to the cost of new drugs. The recently approved prostate cancer drug abiraterone first came on the market at £2,930 for a 30-day prescription – that’s almost £1,000 more for one month’s prescription than the NHS can afford to spend per person per year.
And so NICE initially said no to prescribing it on the NHS in England – even though abiraterone worked and extended life for men with advanced prostate cancer, as well as reducing pain.
It took intense campaigning by Prostate Cancer UK and our supporters before the manufacturers dropped the price and NICE reappraised the drug as an ‘end of life’ drug, allowing them to approve it at a higher cost than a standard drug. But will we always need to put the pressure on pharmaceutical companies for them to discount their drugs enough to make them affordable? Or will value-based assessment mean new drugs get into the hands of men faster? Whatever happens, we’ll keep fighting for men to have access to the drugs they need.
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With prostate cancer predicted to become the most common cancer by 2030, how will we deal with the escalating cost of treatment? Knowing in advance which drugs would work for which people might be one possibility. For example all patients get the same hormone therapy, but it works better for some than others. Personalised treatment would mean that the NHS would be paying for treatments that are more likely to work and at the same time men wouldn’t be experiencing unnecessary side effects and wasting time taking drugs that don’t work – thus representing ‘good value’ all round. We’re not there yet, but we’re funding research into targeted treatments and turning laboratory proven concepts into clinical trials.
Read more about the research we fund.
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