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NHS: Cancer Drugs

Volume 708: debated on Wednesday 11 March 2009


Asked By

To ask Her Majesty’s Government why, following the cancer drug review, the life-extending drugs Tyverb and Sutent are not available on the National Health Service in England.

My Lords, the National Institute for Health and Clinical Excellence appraisals of Tyverb for advanced breast cancer and Sutent for both renal cell carcinoma and gastro-intestinal stromal tumours are ongoing. It would not be appropriate for the Government to pre-empt NICE's final guidance to the NHS. Until NICE issues its guidance, decisions on the funding of these drugs must be taken locally.

My Lords, I am most grateful to the Minister, but there was a total review of cancer drugs by Professor Richards. It is amazing that NICE continues to review these two drugs at such inordinate length, which means that the 1,500 people with advanced stage bowel cancer and the 2,000 with advanced breast cancer—both of which are terminal—are still suffering. Taking that into consideration, does it make sense for the Government, in the past five years, to have funded an increase in clerical staff in the PCTs from 54 million to 115 million? The House will accept that these drugs are expensive, but, after all, do these National Health Service patients not deserve the best? Surely, they can be funded from a reduction in clerical staff in the PCTs.

My Lords, the Government are very concerned to make sure that as many drugs as possible are available to patients with these conditions. The noble Lord will appreciate that Tyverb comes under the heading of a very difficult area. If Tyverb were to be considered by NICE under the flexible approach it is now taking to end-of-life drugs, it is still unlikely that it would be recommended under the quality-adjusted life years measurement used by NICE.

NICE is issuing guidance that Sutent should be available on the NHS to those who have renal cell carcinoma. In the past week, Macmillan Cancer Support has said that this will make an enormous difference to those patients. Every year, 7,000 people are diagnosed with kidney cancer in Britain, and 3,600 of those patients will be eligible to receive Sutent.

My Lords, while we must sympathise deeply with the patients suffering from these serious and incurable forms of cancer and who see these drugs as giving them a prospect of many more months of useful life, would the noble Baroness nevertheless agree that the National Institute for Health and Clinical Excellence is faced, at times, with an almost insuperable dilemma, in having to determine not only the efficacy of drugs but also their cost-effectiveness? Despite that, is it not the case that, if an oncologist can persuade a local health authority or a primary care trust to prescribe one of these drugs for a patient, he or she can do so? Will the Government also confirm that, in the light of their recent decision, in an extreme position any patient wishing to purchase these drugs will not be denied continuing NHS care as a result of doing so?

My Lords, the noble Lord is exactly right about both those issues. The timetable outlined by the Secretary of State on 4 November 2008 means not only that we will deal with issuing guidance faster on these drugs, but also that the flexibility referred to by the noble Lord is built into the system.

My Lords, we have already taken action to improve the speed with which NICE guidance is issued. As I said, my honourable friend the Secretary of State outlined a new appraisals timetable which will mean that, by 2010, the average time taken by NICE to produce draft or final guidance on new cancer drugs will fall well below six months after licensing.

We are determined that the fast-track, single-technology appraisal process will shorten the time taken to bring on new cancer drugs. Building on these improvements, we also intend to extend that provision to achieve timely delivery of guidance, as a matter of course, on all new drugs.

My Lords, I appreciate that this is an extraordinarily difficult area, but I understand that the National Institute for Clinical Excellence says that Tyverb will give only a few extra weeks of life, if that. In many cases, patients may be quite content to have just a few extra weeks or months of life for some family event they are looking forward to. The drug company that manufactures the drug has offered 12 weeks of treatment free to those patients whom the clinicians think may benefit from it if the Government will take up funding thereafter. If the national institute is right, those patients will be dead in a very short time anyway, so why do the Government not take up the offer of the drug company?

My Lords, the noble Baroness is quite right: Tyverb is a very difficult issue and a high-profile drug. Even if the Government were to take up the offer of the drug company, NICE—this is on the website and in the published draft guidance—estimates that the cost of Tyverb per quality-adjusted life year is around £70,000, compared with the normal NICE threshold of around £30,000. The renal drug Sutent, which NICE has recently recommended, costs around £50,000. The noble Baroness will appreciate that we are talking about very difficult and expensive drugs. The matter is still under consultation. The final decision has not been taken. I am sure that this short debate will be fed into the process. Those are the economics of the drugs.