Economics of Cancer and CDF (RE)

Question 1

What is the reason for fragmentation of the oncology market?

Answer 1

74% total sales 2011 were on personalised therapies
Developers are starting to focus on niche subsets for patients with genetic mutations making it harder for drugs to reach blockbuster status.

Question 2

What are Biosimilars?

Answer 2

Like the ‘generic’

A biopharmaceutical drug designed to have active properties similar to one that has previously been licensed.

Question 3

When are biosimilars available and why are they relevant?

Answer 3

Once the patent/licensing has run out the market opens up to smaller companies
On average the cost of the drug reduces by 20%

Question 4

How has the cost of Tamoxifen varied?

Answer 4

In 2011, Tamoxifen (Nalvodex) cost about £1 per 20mg tablet.

Now, the cost of a generic Tamofixen tablet is 8p per 20mg.

Question 5

What are the prices in the BNF?

Answer 5

Public prices; a purchasing pharmacist will have negotiated the price further for NHS use.

Question 6

What is Kadcyla?

Answer 6

Trastuzumab emtansine

Question 7

What is the financial story / controversy surrounding Kadcyla?

Answer 7

In the UK, Kadcyla was not recommended for use by the National Health Service by advisory body NICE, reportedly because an acceptable pricing agreement could not be reached with Roche. Originally it cost £5,900 a month. and NICE estimated it cost £166,000 per QALY (well over the usual maximum). It has been funded by the English NHS Cancer Drugs Fund but in January 2015 it was proposed to remove it from the approved list. After a secret discount was agreed by Roche the Cancer Drugs Fund will continue to fund it.

Question 8

What are NICE technology appraisals?

Answer 8

Technology appraisal guidance are recommendations on NHS

Question 9

What do NICE technology appraisals review?

Answer 9

Review available evidence for clinical and cost effectiveness in medicines, devices, diagnostic technique, surgical procedures and health promotion activities.

Question 10

How is incremental cost calculated?

Answer 10

Total cost of proposal - total cost of comparator

Question 11

How is incremental QALY calculated?

Answer 11

Total QALYs for proposal - total QALYs for comparator

Question 12

What is the Markov Model designed to do?

Answer 12

To represent the disease progression of a cohort of patients (i.e. NSCLC )
The clinical pathway and decision making is aligned with UK clinical practice

Question 13

What stages of disease are included in the Markov Model?

Answer 13

Pre-progression –> Post-progression–> Dead
We want to reduce the transition in patients from 1 to 2
The drug should maintain you at pre-progression.

Question 14

What is the time frame allocated to ‘End of Life’ treatment?

Answer 14

Normally assigned to patient with less than 24 months
There must be sufficient evidence that the treatment offers an extension of life, the addition of atleast 3 months compared with NHS treatment

Question 15

What is a QALY reweighted to in ‘End of Life’?

Answer 15

QALY threshold increased to £50,000 per QALY from £20,000

Question 16

What is Blue Teq?

Answer 16

Scheme that pharmacists in hospitals work under to acquire/request CDF drugs.
Patient access scheme after companies have lowered the original price

Blueteq has a range of healthcare systems that address the needs within both the Public and Private sectors, ranging from the Individual Funding Request (IFR) suite through clinical systems to full patient and hospital management systems

Question 17

When was the Cancer Drugs Fund established?

Answer 17

In 2011, The Coalition outlined their “Programme for Government” and committed to the establishment of a CDF

Question 18

What is the fundamental problem with CDF?

Answer 18

£200m/year was bugeted for 3 years beginning April 2011
Recently the fund was increased to £280m/year in 2016

Overspending everywhere; reevaluation needed.

Question 19

What reasons mean that authorities in England could provide drugs that were not otherwise available on the NHS?

Answer 19

Drugs appraised by NICE and not recommended on the basis of cost effectiveness

Drugs recommended for restricted access

Drugs not, or not yet, appraised by NICE

Question 20

How is access to the CDF determined?

Answer 20

Based primarily on ranking of the drug treatment based on the strength and quality of evidence of clinical effectiveness

Question 21

How can clinicians and patients access drug treatments via the CDF?

Answer 21

The national CDF Cohort Priority List

More commonly, Individual CDF Requests (ICDFRs)

Question 22

Who can prescribe drugs on the CDF Cohort Priority List?

Answer 22

Oncology specialists;

EXAMPLE Pemetrexed in the maintenance of NSCLC

Question 23

Where will we go after the Cancer Drugs Fund?

Answer 23

The joint NHS and NICE England public consultation underway from April 2016
These proposals will maintain access to medicines while data is collected on how to provide treatment in future.