This transcript has been edited for clarity.
I'm David Kerr, professor of cancer medicine from University of Oxford. Today, I'd like to talk about equity of access to cancer drugs.
Those of you who read Medscape regularly will have heard me talk about this issue on the global scale many times. You know that I'm interested in global cancer control and what we can do to help intellectually and financially support our brothers and sisters who deliver cancer care to the very best of their ability in difficult situations.
I'd like to talk about equity of access closer to home though.
Almost 30 years ago, I moved from Glasgow, my hometown, to be a terribly young, green professor at the University of Birmingham. It was a great time for me at a wonderfully welcoming city and university. I guess that's where I learned to cut my teeth in terms of building an academic center and new hospitals and so on.
With fire in my belly then, one of the things I found most distressing at that time was something called postcode prescribing. It was a particular function of the National Health Service (NHS) in the UK at that time. It was delivered through regional and district health authorities who had significant control over the budgets that were spent looking after the local community.
What it meant was that, literally, there were patients who lived on opposite sides of the same street, but because of geographic boundaries, one half of the street was in health district A and the other in health district B. I could prescribe, in those days, expensive cancer medicines for one half of the street but not the other.
There were neighbors who were getting unfair access to drugs. It was crazy. The then–New Labour government — Tony Blair as prime minister and Alan Milburn as our truly fantastic health secretary — with support from a broad group of academics, including myself, set up NICE, or the National Institute for Clinical Excellence (now called the National Institute for Health and Care Excellence).
This is now, I think, a world-famous health technology assessment group. On behalf of the United Kingdom and the National Health Service, they make transparent judgments as to whether we can afford drugs and medical devices of any sort. They do that by looking at the quality of the clinical data supporting any new intervention or drug and then looking at the price and an independent health economic analysis.
They come to a judgment as to whether the data are strong enough and whether the intervention is sufficiently cost-effective to warrant support from our taxation-based NHS. Despite much fist waving, NICE is a force for good and for fairness. I have no doubt about that. The National Health Service is that British institution that unites the whole of the United Kingdom. There is nothing that makes us feel more British than our NHS. It is, I would argue, government's greatest gift to its citizens.
However, we have devolved governments in the United Kingdom. Devolution of responsibility allows budget decisions to be focused on the communities that are most in need so that they can be prioritized. It makes complete sense.
I'm Scottish — you can tell by my strange accent. In Scotland, the government has set up its own medicines approval group.
This can lead to anomalies. This has been highlighted in a recent editorial in The Lancet Oncology — a rather well-written one — on olaparib, which has been approved for the treatment of BRCA-positive prostate cancer in Scotland. With significant improvements in progression-free survival in the pivotal trials, it was moved forward.
Puzzlingly, though, olaparib was not approved by NICE.
There's a possibility that the NICE decision may change. Their initial finding was that there are problems around cost-effectiveness and there was some question about the control arm in the pivotal study, whether it was truly a gold standard or not. Therefore, that has led, at least for the time being, for NICE to say no to olaparib, but the Scottish Medicines Consortium to say yes.
I told you at the beginning about postcode prescribing and a border that was down the middle of a street in Birmingham. Now, we have a border that separates England from Scotland. Citizens of Scotland have access to this drug — a drug that was developed in the United Kingdom and that has drawn significant funding as well as support of patients who were entered in trials and so on.
Scotland says yes and England says no, and that goes against our sense of Britishness. It goes against our sense of collective belief in the NHS and how it should span our national borders.
There's a wake-up message here for the British government and for our Department of Health to get their act together. I think it's unsustainable that citizens in different corners of the United Kingdom can receive different treatments for reasons that aren't immediately clear at all.
This is a clarion call. This is one example (there are others) of saying, "This just sounds wrong to me." If the NHS is the anchor institution that keeps our sense of being British and of coming together — collectivism, as I said before — we need to iron out these bizarre anomalies. We really do. It feels unfair, and wrong, and just not right.
I hope this doesn't sound too parochial, or too navel-gazing in terms of the United Kingdom. There are wider issues here around inequity of access to drugs, as I said before. I'd be interested in what you thought, and I welcome any comments.
As always, Medscapers, thanks for listening. Over and out.
David J. Kerr, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.
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Cite this: A 'Wake-Up' Call to Resolve UK Cancer Drug Access - Medscape - Apr 26, 2022.
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