Last year the UK government announced the establishment of a £600 million cancer drug fund, to be spent over 3 years. This represents a minuscule amount of money compared to the NHS’s annual budget, which is in excess of £100,000,000,000. However, it demonstrates the government’s preference for expenditure on the treatment of cancer over and above other terminal diseases such as multiple sclerosis (MS). Laura Weir of the MS Society recently spoke out in opposition to this special treatment of cancer. I tend to agree with her view, but am I justified?
In recent years an increasing number of newspaper column inches have been dedicated to criticising NICE for rejecting expensive cancer drugs because they are not deemed cost-effective. If we believe the media then the nation is in outrage about this. The prevailing ‘ideology’ in health economics is to evaluate interventions based on the extent to which they satisfy the preferences of the public. This is done by calculating the number of QALYs gained from an intervention and assigning a monetary value to this gain. The government has now implicitly increased this monetary value for cancer drugs, making them more likely to be deemed cost-effective. If we support the use of public preferences, and if the public support extra spending on cancer, then surely we must in turn also support the fund?
Preference for cancer drugs?
The question is whether society is willing to pay more for a drug that helps cancer patients than for a drug that improves or extends the life of anybody else. Is there really a public preference for spending on cancer drugs? I suspect there is, even if this preference has been reinforced and possibly created by the media. To my knowledge there has not been any significant research in this area. If such research did show a preference then it may justify an increased willingness to pay for cancer drugs.
And what about MS?
As somebody whose life has been affected by MS, but not by cancer, I may be bias. Or not. But I believe that expenditure on drugs should be based on the benefit they provide to an individual. Presumably the preference for cancer drugs, if not completely media-driven, is down to the large number of people affected by the disease. When it comes to the amount of money to be spent at an individual level it seems illogical to allow decisions about this to be guided by prevalence. Let’s remember we are not talking about research here, but the fact that an individual with cancer will be allowed to buy expensive (read: less cost-effective) drugs, while somebody with MS will not. I believe this is wrong. But then, I believe that the use of public preferences is not ideal.
Resources are scarce and for every expenditure there is an opportunity cost. An increase in our willingness to pay for the benefits of cancer drugs, at the extreme, leads to a decrease in spending on all other health care interventions. The cancer drug fund raises many questions, not least the possibility that a QALY may no longer be a QALY but may be a cancer-QALY. I believe this is dangerous territory.
Does this issue leave you questioning public preferences? Should we be prioritising treatment for cancer? Or is this all simply a fabrication by the media?