By Danni Manzi, Head of Policy and Campaigns – Breast Cancer Care
At the beginning of April, NHS England approved a new funding system for medicines that changes the way drugs, including those for breast cancer, are made available. The pros and cons have been widely debated, both before and after the decision was made, yet the real crux of the matter – the decision to have a £20 million threshold – has still not been explained by NICE or the NHS.
The new regime, which came into force on 1 April, is fundamentally flawed. It means that, even if a drug is found by NICE to be clinically and cost-effective, routine access to it could be dramatically delayed by NHS England if it is expected to cost more than £20 million a year in any of its first three years on the NHS. This means it could be years before innovative new drugs, which could extend lives, see the light of day.
As the leading UK-wide support charity for people affected by breast cancer, Beast Cancer Care is deeply concerned that this change will have a devastating impact on breast cancer patients, and prevent them getting the drugs they so desperately need. Under a £20 million Budget Impact Test, it’s almost inevitable that new breast cancer drugs would be placed out of reach.
Drugs for incurable secondary breast cancer are already routinely rejected for being too expensive, so throwing down another gauntlet could block access to even more treatments. Women with incurable breast cancer are already living with huge uncertainty every day – they do not need added anxiety about whether they will get the drugs that could give them precious extra time with their loved ones.
On the other side of the coin, the sheer number of people with primary breast cancer means even a relatively cheap drug could end up being pushed over the £20 million mark. Is it fair that women should miss out on the newest, most effective treatments simply because they are one of almost 62,000 people diagnosed with the same disease each year?
Of course, every system has to have limits, and drug companies absolutely have a role to play in bringing drugs to the market at the best possible price. But our worry is that this £20 million benchmark has been set with no evidence as to how viable it is, and how many patients will be affected as a result.
NHS England has failed to explain how they arrived at £20 million as the cut-off point, despite numerous attempts on our part to obtain this information. It is completely unacceptable that such an important change has not been properly justified, yet looks set to dictate whether patients will receive the best possible treatment.
This inexcusable delay to accessing medicines goes against the NHS constitution, which states that patients have the right to drugs and treatments approved by NICE for use in the NHS, if their doctor says they are clinically appropriate for them. We are stunned that neither NICE or NHS England have listened to the many concerns raised by so many individuals and organisations.
We cannot prioritise cost above patients, and it is unacceptable that this topsy-turvy approach is being allowed to go ahead in its current form. Women with breast cancer deserve the best care possible from day one – which will be made impossible under this system.
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