Putting Expensive Cancer Treatments out of the Market? the Case of the Cancer Drug Funds in UK

Health care systems in Western countries are nowadays confronted with multiple difficulties that put into question their solvability and their durability. One of these challenges is their capacity to provide effective and efficient care to the population despite the crisis of public finances and the evolution of health problems. The question of the efficiency and effectiveness of treatments for chronic diseases is presented as central for the future, in terms of public health but also in terms of public finances. The expenditures related to patients suffering from chronic disease are identified as a crucial issue for health economics and public authorities. Many kinds of these chronic diseases can be mentioned: chronic kidney disease, chronic obstructive pulmonary disease, asthma, cancer, diabetes, cystic fibrosis, myopathy, etc. Cancer is one of the most important chronic diseases, both in terms of cost for the health care system and incidence in the population. For example, 331 000 cases of cancer were diagnosed in UK in 2011.

Until the 2000’s, surgery, radiotherapy and chemotherapy have been the three kinds of treatment for cancer. Since the middle of the 2000’s a new kind of medicine has been developed: the personalised medicine. It consists in specific molecules given to the patient in association with more classical chemotherapy. Two critics are formulated by now: these drugs have uncertain effects (for the most sceptical actors it has minimal effect on the patient survival) and their “cost” is extremely high. Nevertheless public authorities can today hardly refuse the access to the market to these drugs for two reasons: the week effect of theses treatment does not mean that any improvement can be achieved in the future; the cost of drugs appears not as a robust argument for denying the access for the patients. Recent innovations in terms of cancer treatments have raised the controversy about their cost in every country that has decided to promote them. It is especially the case in the United Kingdom where every new medicine must be cost-effectiveness. The National Institute for Health and Care Excellence does the medico-economic evaluation and has established a threshold for new drugs. Calculating the cost-effectiveness of the drug it consists in balancing the effects of the medicine (calculated in Qalys) and its cost. For usual medicine, the threshold is £30 000 but for cancer drugs it is £50 000. But even this higher threshold is not enough to accept on the market the new cancer drugs that are produced by the pharmaceutical industries as personalised treatments. The English Health Care System has therefore been forced to invent a specific mechanism that tends to create an economic and political exception concerning these drugs that have a usual price around £150 000. The Cancer Drugs Fund has been created in 2011. On the website of the Cancer Research UK, which is an organization in charge of promoting research and information about cancer, the Cancer Drug Fund’s aims are described as follow: “This may be because the drugs haven’t been looked at yet. Or it may be because NICE have said that they don’t work well enough or are not cost effective. The aim of the fund is to make it easier for people to get as much treatment as possible”.

            My interest in the Cancer Drugs Fund is to explore how health innovations imply new political economy of cancer and how the British State try to render accessible drugs that are extremely expensive. It supposes that the “old State’s metrological devices” as costs per Qalys are not able to promote the access to drugs in an effective way. How the Cancer Drugs Fund embedded a new composition of the political economy of cancer that is characterized by two aspects: 1) the possibility for the State to renounce to its costs-effective perspective when it appears that drugs are too important; 2) the incapacity of the State to obtain lower prices for these drugs and the necessity to create an specific fund to buy them.