Developing a drug is an expensive endeavour. The cost of research, testing and development often runs into the billions. Even then, many treatments never reach the final lap, being found to be ineffective or dangerous along the way.
So there can be little surprise at the disappointment of Pascal Soriot, the boss of AstraZeneca, on news that Britain’s National Health Service will not be paying for “olaparib”. Mr Soriot described himself as “perplexed” at a decision that prevents British patients from accessing a treatment found to slow the progress of ovarian cancer.
At first glance, Mr Soriot’s bafflement is hard to understand. Olaparib costs £4,200 per month, far higher than is deemed acceptable for its likely benefits by the National Institute of Health and Care Excellence (Nice).
Nice was established to make this kind of judgment, in full knowledge that every pound used on one treatment is a pound taken from another. Wrong decisions come at a heavy cost.
The most pertinent recent example is the Cancer Drugs Fund, which was set up to pay for treatments that fail Nice’s normal test of value for money. As well as inflating the cost of some drugs, academics have found that the £200m it has disbursed could have generated five times the benefit if returned to the NHS.
It would be easy to dismiss Mr Soriot’s complaint as special pleading. This is not the first time the pharmaceutical industry has taken aim at Nice; last summer, Swiss drugmaker Roche accused it of being “ no longer fit for purpose” after it similarly blocked Kadcyla, a breast-cancer drug that costs £90,000 for a course of treatment. In return, the industry is accused of trying to infect Europe with the indefensibly high prices that it is allowed to charge in the unregulated US market.
More charitably, Mr Soriot is highlighting a contradiction in how UK industrial policy treats the life sciences. Politicians applaud companies that invest in research and reward them with lavish tax breaks. As much as the discovery of life-saving medicine, their motivation is to build a world-leading industry making the most of Britain’s excellent science base. Yet at the same time they allow the NHS to undermine the market for the drugs that are the fruit of all this investment. In the words of Mr Soriot, “innovation has to be rewarded”.
This quarrel comes against a backdrop of growing excitement in cancer research. Immunotherapy treatments, which make use of the body’s own natural defences, are seen as opening a “new front” in the war against cancer. Results should not be overhyped; a successful trial usually means a life extended by just a few months, with a persistent risk of serious side effects. But such incremental innovations might build towards a significant breakthrough, and the industry is right to warn against this being stifled by too short-term an approach.
Yet there is no value in rewarding innovation that leads to products far too expensive for the NHS’s heavily constrained budget. Doing so denies existing patients the proven and cost-effective treatment they need today, in pursuit of a future breakthrough from which they might never benefit.
Supporting innovation and caring for current patients are both important, but they are distinct agendas and should be treated as such. For the former, a more honest approach would be to scrap the Cancer Drugs Fund altogether, and use the money for research and development. As for patient care, Nice may not be perfect but it is carrying out the job it was set up for, and should be left alone to do it.
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