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Cancer Care's Chain Reaction

By Darren Fergus

In our last blog, ‘Cancer Drugs Fund is here to stay’, we made some pre-election predictions and asked the question on many people’s minds, ‘Will the Cancer Drugs Fund exist in the next parliament?’

As we predicted the Conservatives have brought the CDF into NICE, but not dissolved the CDF into NICE.

However mergers often see the dominant partner eventually take over, and slowly but surely the Cancer Drugs Fund will inevitably be dismantled in all but name under the surreptitious eyes of the Conservatives.

If we believe this to be true, what sorts of things should we be thinking about?

Let’s begin by looking at breaking news from the European Cancer Conference in Vienna, Austria. Opdivo (nivolumab) demonstrated superior overall survival versus standard of care in advanced renal cell carcinoma, which is big news for kidney cancer.

Dr James Larkin, consultant at the Royal Marsden Hospital, acknowledged this by saying ‘It's another big day for immunotherapy for cancer and one of the biggest days for kidney cancer for some time.’

In the UK Bristol-Myers Squibb will be seeking reimbursement for Opdivo in advanced renal cell carcinoma. After 2 rounds of delisting drugs from the national Cancer Drugs Fund NICE may seize a political opportunity to look positively upon Opdivo, and assuming the numbers can stack up it is very likely Opdivo will be funded by NICE for this indication.

Looking beyond Opdivo and putting our lens over the other immunotherapy drugs in development it is clear the pharmaceutical industry faces a new problem.

Payers are asking how do we fund a host of immunotherapies coming through that may actually only show marginal outcome benefits over one another?
However, they are also asking, ‘How do we justify not diverting funds away from cancer drugs and into drugs such as those that promise to wipe out chronic diseases like Hepatitis C?’

We predict we will start to see innovation redefined, instead of innovation in clever mode of actions that reactivate T-cells to fight cancer, we will start to see innovation more simply defined in outcomes. If your cancer drug delivers significant improvements over standard of care, e.g. many months improvement in overall survival, it can be defined as innovative.

Therefore a value-based price for all immunotherapies (and other classes of cancer drugs) makes sense from a payer perspective; and if your cancer drug delivers many months improvement in overall survival this outcome innovation may be rewarded with a higher price over the value-based price.

But who pays the difference, NHS England, insurers or patients themselves?

If we look to the southern hemisphere this model of a value-based price for a class of cancer drug with patient self-pay top-ups for price differences from additional drug benefits is working well.

As we shift into the next parliament the £30bn NHS savings target may see self-pay top-ups discussed as a real long-term solution to the NHS funding crisis, however this is a societal shift in a country that delivers ‘free’ healthcare.

We need to think as a Pharma industry about the payer options for tackling a host of immunotherapies and other drugs coming through to tackle cancers, whilst not letting our eye off the ball of what is happening now.

The first thing that is happening now is the Cancer Drugs Fund is ‘merging’ into NICE. NHS England has done an excellent job of improving access to cancer drugs and now NICE has to follow in its footsteps. Therefore anyone who is preparing for reimbursement of their cancer drug should understand the short-term linkages between the Cancer Drugs Fund and NICE. Understanding the linkages is important and something Why Health is devoting agency time to.

The other thing that is happening now is the real debate of ‘how do we sensibly deal with the classes of cancer drugs?’ At Why Health we are scenario planning what NICE supported by experts from NHS England will decide to do in the short-term. There are simply too many new drugs on the horizon line to not sensibly consider new short-term solutions for classes of cancer drugs.

Planning for the option of a status quo is always a consideration, but not a sensible one. As we have just said, there are simply too many new drugs on the horizon line to sensibly assume things will stay the same.

Therefore anyone who is preparing for reimbursement of their cancer drug should have scenarios planned for that look very similar to the post-it notes, scribbles and sketches we have plastered over a section of the Why Health office.

But this isn’t all about cancer drugs, although you would be forgiven for thinking otherwise. Specialised Commissioning will be watching what NICE does next with the ‘Cancer Drugs Fund’. And what happens next will cause a chain reaction in NHS England sparked off by how Specialised Commissioning learns from the next game play in NICE…

This will be the chain reaction of cancer care.
Why Health is a specialist healthcare agency
Not your run of the mill medical education agency or market access consultancy, because at Why Health we don't exist in isolation. Your marketing plan doesn't sit in silos and neither do we. At Why Health we specialise in bringing a holistic approach to you, working in parallel with your marketing plan to deliver what you need.
That's why we are a specialist healthcare agency.
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