cancerpartnersuk the nhs and cancer care karol sikora, medical director professor of cancer medicine...
Post on 01-Jan-2016
216 Views
Preview:
TRANSCRIPT
CancerPartnersUK
The NHS and cancer care
Karol Sikora, Medical DirectorProfessor of Cancer MedicineImperial College, LondonMarch 2009
What people living with cancer want
the best chance of cure with good quality of lifehonest, clear information on available optionsto have the diagnostics fast-tracked to 3 daysto see the same specialist at every visitto access the latest scientific developments convenient, streamlined, focused services as
close to home as possible with dedicated car parking
to be treated in a decent environment with dignity
to get the best care without worrying about its cost
The National Cancer Plan – 9 years on
Up to £0.5bn added per year to NHS cancer care for last 5 years – but this now stops
NHS budget tripled to £102bnTarget metrics in place but still running with
huge under capacity in diagnostics and RTStaffing problems in RT leading to delays,
rationing and lack of innovationFinancial meltdown imminent - high cost drugs,
IMRT and lack of ambulatory care facilitiesContinual evolution of stakeholders - PCTs,
SHAs, Cancer Networks and NHS Trusts Increased patient empowerment and demandSurvival data still poorest amongst EU13
Eurocare 4 - four commonest cancers
0
10
20
30
40
50
60
70
80
90
ENG FRA GER SWI POL
colon
lung
breast
prostate
all
5
NHS
CORE SERVICES
Novel drugsNovel devicesAdditional therapiesComplementary medicine
DEMAND LED SERVICESTIME
The cancer demand pyramid
NHSInsurersRegulatorsNICE Politicians
PharmaProvidersPatientsAdvocacyPoliticiansSocietyLegal
Breast
Lung
Colorectal
Prostate
20102000 2005
2010 20152000 2005
2010 20152000 2005
20102015 20202000 2005
KeyMAbs
Vaccines
Anti-Angiogenesis
Kinase Inhibitors
Apoptosis Inducers
Anti-Sense
Gene Therapy
2015 2020
2020
base case launch years in the US
Predicted NDA dates for molecular therapiesPredicted NDA dates for molecular therapies
7
Targeted therapies could lead to financial meltdown
drug generic manufacturer
yearly cost
Herceptin traztuzumab Roche £60K
Mabthera rituximab Roche £50K
Nexavar sorafenib Bayer £30K
Glivec imatinib Novartis £60K
Erbitux cetuximab BMS £50K
Avastin bevacizumab Genentech £60K
Tarceva erlotinib Roche £40K
Sutent sunitinib Pfizer £40K
Tykerb lapatinib GSK £30K
Iressa gefitinib AZ £40K
NICE - Trastuzumab (Herceptin) early breast cancer
Jun 05 ASCO data presentedAug 05 DH referred to NICEOct 05 Health Minister announces
availabilityNov 06 Debated in ParliamentDec 05 Patient goes to High CourtApr 06 Patient wins in CourtMay 06 EMEA approvalJun 06 NICE publishes positive draft
guidanceAug 06 Fast-track guidance published by
NICE
8
NICE - Sunitinib (Sutent) renal cell cancer
Jan 06 FDA accelerated approvalJul 06 EMEA Market authorisationJun 08 Health Minister says top-ups not
allowedAug 08 NICE negative final guidanceAug 08 protest from 26 academic oncologistsDec 08 DH review backs top-up paymentsFeb 09 NICE draft guidance approves 1st line
onlyFeb 09 newspaper protest at unfairnessFeb 09 NICE permits 2nd line use after IFNMar 09 final guidance due
9
NICE - Lapatinib (Tyverb) breast cancer
Feb 07 final scoping studyMar 07 FDA NDA passedApr 07 closing date for evidenceJan 08 1st appraisal meetingJun 08 EMEA market authorisationSep 08 2nd appraisal meetingNov 08 3rd appraisal meetingJan 09 4th appraisal meetingMay 10 expected guidance
13
14
Ratio of E13: UK and TOP COUNTRY: UKDRUG GENERIC UK E13 TOP COUNTRY CANCER
ERBITUX cetuximab 1 10 22.5 FR colon
SUTENT sunitinib 1 3.1 4.8 AS renal
VELCADE bortezomib 1 2.7 5.3 FR myeloma
NEXAVAR sorafenib 1 6.7 13.5 FR renal, liver
AVASTIN bevacizumab
1 7.6 18.0 FR Colon, breast
TARCEVA erlotinib 1 5.3 11.7 FR Lung, pancreas
HERCEPTIN traztuzumab
1 1.2 1.7 SW breast
M&C Cancer Network: PCT spending on cancer
Spend on Cancer by PCT 2004-5
-
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
Bebington &West Wirral
EllesmerePort AndNeston
SouthSefton
Know sley St Helens NorthLiverpool
Birkenhead& Wallasey
CheshireWest
Southportand Formby
SouthLiverpool
CentralLiverpool
Warrington WestLancashire
Sp
end
(£
Mill
ion
s) p
er 1
00,0
00 U
nif
ied
Wei
gh
ted
Po
pn
England Average
18
Are you ill?
No
Yes
Have you got cancer?
No
YesNo
Yes
Have you got medical insurance?
Check the cover. Some insurers are beginning to limit benefits
Remain an NHS patient
NHS oncologist is willing and able to prescribe the most effective drugs? No
Yes
Prepared to self fund?
Legal challenge – There is no legal reason as to why patients cannot top up their NHS care
Survive on NHS
Win
Purchase drugs for oncologist to administer on NHS
No
Yes
No Yes
Will the oncologist let you top up your cancer care while remaining an NHS patient?Some oncologists will let you purchase cancer drugs that can be administered as an outpatient and remain an NHS patient. It gets more complicated, if the drug needs to be administered in hospital.
Intimate wish to take up residency and drug will be prescribed Is the drug available
in England, Scotland, Wales or Northern Ireland Yes No take up residence?
Purchase a second opinion until Yes
Complain to the Chief Executive of Hospital (copying the Healthcare Commission)
Complain to local PCTIt is generally accepted that the majority of cancer sufferers who challenge their PCT win
No
No
Yes
No
Yes
Yes
Survive on NHS
Make cancer charities aware of your challenge – they can be a mind of information
If your case goes to the PCT Exception Committee and it is declined – challenge the decision and the authority of its members
Write to your local MP
Get in touch with Doctors for Reform, Halliwells Solicitors, Pamela Northcott Fund
Get as much publicity as possible and do not accept what you are given Get in touch with the drug manufacturer
Win
Survive on NHS
Fail
No
Yes Win
Survive on NHS
Fail
19
Providing cancer care in 2029 Cancer as a chronic, controllable illness
Governments as regulators and insurers – not providers
Healthcare, insurance, pharmaceutical, academic partnerships create novel global provider vehicles
Personalised medicine, NPT black box systems, implanted chip monitors, molecular diagnostics
Cancer ‘hotels’ in most towns New roles for cancer professionals Empowered informed consumers not patients –
option appraisal Co-payment – biomarkers to reduce costs Total care and compressed morbidity
top related