Abstract
Background
Decision-making processes that determine cancer drug availability vary internationally.
The National Institute for Health and Clinical Excellence (NICE) assesses clinical
and cost-effectiveness, but recent restrictions on the availability of cancer drugs
suggest that NICE may be getting tougher.
Objectives
To determine whether NICE is rejecting a higher proportion of cancer drugs and whether
the reasons for restricting technologies have changed.
Methods
NICE decisions on cancer drugs from May 2000 to October 2008 were classified as ‘positive’,
‘restricted’ or ‘negative’, and decisions taken before and after a change in NICE’s
appraisal methods in August 2006 were compared. NICE’s stated reasons for its restrictions
were analysed.
Results
Fifty-six cancer drugs in 38 appraisals were analysed. The proportion of ‘negative’
appraisals increased from 4% in period 1 to 27% in period 2. Findings were similar
when analysed by drug assessment (11% versus 26%).
Conclusions
The higher rejection rate for cancer drugs is partly explained by the new appraisal
process, but the principal reason for the observed change is the shift from an absence
of evidence on cost-effectiveness to evidence of an absence of value-for-money.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A pan-European comparison regarding patient access to cancer drugs.Karolinska Institutet and the Stockholm School of Economics, Stockholm2005
- Paying for modern cancer care – a global perspective.Lancet Oncol. 2007; 8: 749-751
- The legal obligation for government funding.Oncol Exchange. 2007; 6: 43-44
- Drugs for cancer and copayments.BMJ. 2008; 337: a527
- Market access for cancer drugs and the role of health economics.Ann Oncol. 2007; 18: 55-66
- EuroScan. International diffusion of new health technologies: a ten-country analysis of six health technologies.Int J Technol Assess Health Care. 2006; 22: 419-428
- Health systems in transition.World Health Organization on behalf of the European Observatory on Health Systems and Policies, Belgium, Copenhagen2007
- The effect of priority setting decisions for new cancer drugs on medical oncologists’ practice in Ontario: a qualitative study.BMC Health Serv Res. 2007; 7: 193
- Recent developments in pricing and reimbursement of medicines in Ireland.Expert Rev Pharmacoecon Outcomes Res. 2007; 7: 605-611
- Paying for costly pharmaceuticals: regulation of new drugs in Australia, England and New Zealand.Med J Aust. 2008; 188: 26-28
- Health care coverage determinations: an international comparative study.Open University Press/McGraw-Hill Education, Maidenhead2005
- Evaluations of health interventions in social insurance-based countries: Germany, The Netherlands, and Austria.Health Policy. 2003; 63: 187-196
- Organization of health care systems and financing of pharmaceuticals in Norway, including cost containments.J Pharmaceut Finance Econ Pol. 2003; 12: 351-360
- Health technology assessment and priority setting for health policy in Sweden.Int J Technol Assess Health Care. 2004; 20: 44-54
- SMC briefing note (June).SMC, Glasgow2008
- New medicines approval.SMC, Glasgow2008
- Press release 2005/027: NICE to issue faster drugs guidance for the NHS.NICE, London2005
- Guide to the single technology appraisal process.NICE, London, Manchester2006
- National Institute for Clinical Excellence and its value judgments.BMJ. 2004; 329: 224-227
- Guide to the methods of technology appraisal.NICE, London2008
- National Health Service Act, 1977: directions to health authorities, primary care trusts and NHS trusts in England.HMSO, London2001
- Has NICE been nice to cancer?.Eur J Cancer. 2006; 42: 2881-2886
- European perspective on the costs and cost-effectiveness of cancer therapies.J Clin Oncol. 2007; 25: 191-195
- Many new cancer drugs in the United Kingdom are facing negative NICE rulings.J Clin Oncol. 2007; 25: 2635-2636
- In reply.J Clin Oncol. 2007; 25: 2637-2638
- NICE technology appraisal guidance 33: guidance on the use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer.NICE, London2002
- NICE technology appraisal guidance 107: Trastuzumab for the adjuvant treatment of early-stage HER2-positive breast cancer.NICE, London2006
StatsDirect Statistical Software (version 2.6.6). StatsDirect Ltd.; 2008.
- Press release 2008/040: NICE drug reviews terminated when manufacturers fail to submit evidence.NICE, London2005
- Press release 1999/0485: NICE to tackle variations in treatment quality and cost.NICE, London1999
- Press release 2008/066: NICE announces measures on end of life medicines.NICE, London2008
Article info
Publication history
Published online: January 12, 2009
Accepted:
November 26,
2008
Received in revised form:
November 25,
2008
Received:
November 6,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
