It is looking increasingly likely that PharmaMar’s Yondelis will not be available on the National Health Service for patients with ovarian cancer, after cost regulators again rejected the drug on questions over efficacy.
The National Institute for Curbing Expenditure (NICE) has republished draft guidance turning down the use of Yondelis (trabectedin), in combination with pegylated liposomal doxorubicin (PLDH), as a treatment for ovarian cancer that has returned six months or more after initial treatment with chemotherapy, including platinum for platinum-sensitive disease.

Ovarian cancer is the fifth most common cancer in women in the UK, with more than 6,500 patients diagnosed every year.

In around 80% of cases the cancer will return following first-line treatment, and it is estimated that just over two fifths of these could be eligible for treatment with Yondelis, a marine-based anticancer drug derived from the sea-squirt that attacks cancer cell DNA to prevent cell growth and spread.

But the Institute’s Appraisal Committee said it has serious concerns over how Yondelis’ effectiveness compares to that of other treatments available on the NHS. Crucially, PharmaMar did not submit any evidence comparing its drug to platinum-based chemotherapy regimens in treating relapsed disease, despite the latter being the gold standard therapy in such cases.

“This means that we cannot be sure that [Yondelis] extends patients’ lives for longer than the most routinely used treatments,” explained NICE chief executive Andrew Dillon.

Evidence ‘not robust’

New evidence considered did suggest that Yondelis might be most effective in women with ‘partially platinum-sensitive’ ovarian cancer, i.e. when the disease comes back between six and 12 months after initial platinum chemotherapy.

However, the Committee said it was not sure that the effectiveness of the drug in this subset of patients was “genuinely different from that seen in the wider group of patients for which the drug is licensed”, and so concluded that the data were not robust enough.

Taking all the uncertainties into account, the Committee calculated that the incremental cost-effectiveness ratio (ICER) for Yondelis could be higher than £95,000 per QALY gained for the entire eligible population, and £68,000 for the partially platinum-sensitive subgroup, despite a proposed patient access scheme under which PharmaMar offered to pick up the tag for treatment with its drug following the fifth cycle of treatment.

“Even when taking into consideration the Patient Access Scheme, through which the manufacturer limited the total cost of the drug, the committee concluded that the cost of trabectedin was too high relative to the uncertain benefits it may provide patients,” Dillon said.

Meanwhile, the Institute has announced that Sir Professor Sir Michael Rawlins has been reappointed as its chair for another year’s term, until March 31, 2012.

Professor Rawlins has held the position since NICE was created by the then Labour government in 1999 to curb the NHS’s expenditure on drugs.

From: http://www.pharmatimes.com/Another_NICE_no_for_PharmaMar_s_Yondelis

Dying cancer patients have been refused costly life extending drugs on cost grounds despite a Government promise to end the “scandal” forever.
Their requests have been rejected by regional health authorities who were accused of operating covert “blacklists” to restrict dozens of treatments to save money.

An investigation by The Sunday Telegraph has uncovered more than 80 cases in which desperately sick NHS patients have been refused the cancer drugs their doctor sought, in the four months since a £200 million fund was introduced to stop health authorities rationing treatments.

The fund was a key move by the Coalition so that those suffering from cancer would never again be refused drugs on grounds of cost.

Ministers were responding to years of anger over a system which meant patients were unable to secure life-extending drugs because central NHS rationers had decided the treatments were not “cost effective”.

Announcing the fund last summer, Andrew Lansley, the Health Secretary, promised to end “the scandal” of cancer patients being refused the drugs that their doctors sought, because of restrictions by the National Institute for Health and Clinical Excellence (NICE).

A £50 million stopgap version of the fund was launched in October, before the annual £200 million investment starts in April.

But this newspaper’s investigation has raised serious concerns over its operation, including:
* At least 86 cases involving terminally-ill patients being turned down;
* Extreme variations in access to drugs, with one NHS region promising free access to more than three times as many cancer treatments as another;
* Local policies so restrictive that in many parts of the country, consultants are expected not to even bother asking for drugs which are not on the “priority lists”.

In its first four months, the fund has paid for approximately 1,300 patients’ drugs – even though research last March suggested up to 20,000 cancer patients’ lives were being shortened each year by drugs rationing.

The Government has allowed each NHS regional health authority to set its own rules about which drugs are put on priority lists, creating a postcode lottery across the country.

If treatments are not on the list, patients and their doctors have to fight harder to justify why they should get them.

Bureaucrats have created complex structures, leaving terminally-ill patients to spend their last months fighting for drugs which could increase their survival.

The policies say every possible funding route for drugs must be exhausted before the NHS will even consider dipping into the fund.

Cancer charities warned that some NHS authorities were attempting to “drive a coach and horses” through the Government pledge.

They fear the £50 million fund may actually end the financial year underspent because of the restrictions.

Andrew Wilson, chief executive of charity The Rarer Cancers Foundation, said: “We are deeply concerned that health authorities are creating really restrictive policies which go entirely against the spirit of the fund – which was that clinicians would be able to decide what treatment their patients need.

“Some organisations are effectively operating blacklists of drugs, while others are making every patient go through lengthy bureaucracy to apply as an exceptional case, when in fact they are a cancer patient requiring treatment should be sufficient. The way some of these organisations are operating drives a coach and horses through the principle of the scheme.”

In most parts of the country, if a patient requires a treatment such as Avastin for bowel cancer – which NICE says is too expensive – their doctors must first apply to see if their primary care trust will fund it as an “exceptional case”.

If that is refused, as would normally be the case, a separate application is then made to request authorisation from the cancer drugs fund – and if that too is refused, patients and doctors are left to attempt an appeal.

Patients refused include those seeking Avastin for advanced bowel, breast and brain cancer, Tyverb for breast cancer and drugs to treat tumours of the bladder and kidney.

NHS authorities said they had turned down requests because they did not think there was enough evidence patients would benefit from drugs their doctors sought. In other cases, they were refused help because their medical history did not match the precise criteria drawn up by trusts.

There is also concern over the “postcode lottery” in availability of drugs.

NHS North West has cited 22 drugs which should normally be funded – while NHS South Central, spanning five counties from Oxfordshire to the Isle of Wight, lists just six treatments which would automatically be allowed.

The policies are so restrictive that in Yorkshire and the Humber, just 82 patients have been given funding. Yet across the East of England, with a similar population, 201 cases were funded.

Even those areas which seemed to have the most generous policies have tightened their belts as end of financial year approaches.

In the North West, which had backed the use for Avastin for some advanced breast cancers, and Glivec for cancer of the stomach, says patients who have not been given funding will now have to wait until April before their cases are even considered.

Several have changed their rules even in during the four months since the fund was set up, so that several patients in London were denied drugs under one set of criteria, only to have their cases reconsidered all over again as their health declined.

Mike Hobday, head of policy at charity Macmillan Cancer Support, said he was “very worried” by the findings of the investigation.

He said: “Every cancer patient should get the drugs their doctor recommends, regardless of what type of cancer they have, or where they live.

“A few extra months towards the end of a patient’s life can mean the difference between seeing a child get married or graduate.”

Health Minister Anne Milton said: “Since October, more and more patients are being treated with life-extending drugs that they wouldn’t have got under the previous system. Demand for the fund will vary across the country; we set up the fund in order to balance out existing variation in access.”

From: http://www.telegraph.co.uk/Cancer-sufferers-refused-life-extending-drugs-despite-Government-pledge

Men with prostate cancer are five times more likely to die in some parts of the country than others, highlighting a “postcode lottery” in NHS care, campaigners claim.Experts warned that inequalities in care across the country were “getting worse”.

The disease is one of the most common forms of cancer in men. About 35,000 men are diagnosed with prostate cancer in Britain every year and about 10,000 die from the disease.

Figures show that men diagnosed with the condition in south east Cambridgeshire are almost five times less likely to die from the disease than those in Tottenham, north London.

The statistics, collated by the Prostate Cancer Charter for Action, also show that 96 of England’s 529 parliamentary constituencies have a death rate 25 per cent higher than the England average.

The figures show that in Tottenham, 57 men per 100,000 died from the disease, 131 per cent higher than the national average.

In south east Cambridgeshire the figure was 12 per 100,000.

An earlier report found that areas of the country which had failed to implement NHS guidelines on improving care had a mortality rate 4 per cent higher than those areas were the guidance had been taken up.

Dr Frank Chinegwundoh, a consultant urologist, said: “It is not enough that prostate cancer services are improving as a whole, if patients face such a lottery in the care they receive.”

“We need better services for all patients across the country, not just a lucky few.”

David Smith, of the Prostate Cancer Support Federation, said: “All men with prostate cancer should benefit from better services, yet these figures suggest that the inequalities in prostate cancer are getting worse.

“There can be no excuse for services in some areas of the country to be performing so much worse than in others.

“This situation cannot be allowed to continue.”

Mark Simmonds, the Tory shadow health minister, said: “We have been warning for some time about the inequalities in access to treatment for cancer.

“We want an NHS focused around the needs or patients and the outcomes they want to see.

“And the way funding is allocated to local NHS organisations needs to reflect the burden of disease across the country better.”

Professor Mike Richards, the NHS’s national clinical director for cancer, said: “The Department of Health recognises the importance of implementing the Improving Outcomes Guidance published by NICE and we have asked Strategic Health Authorities to submit action plans to demonstrate how they will implement this.

“Raising the public awareness of prostate cancer is one of the key challenges for the future. We want men to know what their prostate is, what it does, and what can go wrong with it and we are tackling this through the National Awareness and Early Detection Initiative.

“Also for the first time, as a result of the work of the Prostate Cancer Advisory Group, we now have a definitive set of consistent key messages for the general public about the prostate, including prostate cancer. These clear messages provide men and their families with information about the prostate that they need to be aware of and are designed in such a way as not to cause unnecessary anxiety.”

From: http://www.telegraph.co.uk/health/healthnews/5531954/Postcode-lottery-in-protate-cancer-treatment.html

The Amercians have a phrase for their version of NICE- the death panel. Now at last the National Institute for Curbing Expenditure (NICE) is to lose its power to decide which drugs are too expensive. The government’s drug rationing body, Nice, is to be stripped of its power to turn down new medicines for use in the NHS, ending emotive battles with patient groups but raising the spectre of a postcode lottery for care.

The health secretary, Andrew Lansley, believes that Nice should continue to write guidelines for doctors on the best treatments for their patients, but the Guardian understands he will remove its controversial power to ban the use of drugs it considers too expensive for the benefit they offer.

The move will be greeted with enthusiasm by the pharmaceutical industry, which has opposed Nice from the outset, and by certain patient groups, set up to lobby on specific diseases, sometimes with pharma funding, that have joined cause with them in angry denunciations of Nice when drugs found to have limited benefit have been rejected.

But the decision is likely to cause consternation among the supporters of Nice, who warn of a return to the “postcode lottery” days before Nice came into being, when some patients could get the drugs they wanted on the NHS but others could not.

Critics also point out that careful scrutiny of the cost-effectiveness of drugs is essential to keep drug bills down and ensure that NHS money is not spent on medicines with very limited effect – to the detriment of other patients who may not get the care they need.

“Real growth in the NHS will be about 0.5% in the next few years,” said Alan Maynard, a health economist. “We’re going to have rationing. The question is whether we have it at a national level or let 150 primary care trusts or whatever do it their own way.”

David Cameron’s announcement of a £200m fund for new cancer drugs, made during the election, “drove a coach and horses through Nice”, said Maynard. He said he thought Nice was “under considerable assault”.

Lansley wants the decision on whether a patient should get a drug to be moved back to the patient’s doctor. The local commissioning body will be asked to agree to pay for it. The cost of the drug will be decided through a new “value-based pricing” system.

The NHS will negotiate with the manufacturer on a price for each new drug, taking into account not only how clinically effective it is and how it reduces the burden on the patient’s carers but also what other treatments are available and how “innovative” the company has been in producing the drug.

The health secretary told the Guardian that reforming the way medicines were paid for would help ensure money was spent wisely.

“We need a system that encourages the development of breakthrough drugs addressing areas of significant unmet need. And we need a much closer link between the price the NHS pays and the value that a new medicine delivers, sending a powerful signal about the areas that the pharmaceutical industry should target for development,” he said.

“Most importantly, using our cancer drugs fund in the interim, and value-based pricing for the longer-term, we will move to an NHS where patients will be confident that where their clinicians believe a particular drug is the right and most effective one for them, then the NHS will be able to provide it for them.”

The pharmaceutical and biotech industries have heavily lobbied governments for a long time, arguing that Nice is an obstacle to innovation, delaying the introduction of their new drugs into the NHS and sometimes turning them down or restricting the numbers of patients for whom they can be used. Under the new system, they will be able to argue for a premium price for a drug in a new class, for instance, or for one that has required a greater outlay for research and development.

According to the pharmaceutical press, health minister Lord Howe told a conference last week on the future of innovation and drug research and development that Nice was now “somewhat redundant” when it came to deciding the cost-effectiveness of drugs, although its role in producing guidance would remain very important. Howe said the price to be paid would reflect “everyone’s agreed perspective” on its value.

Dr Richard Barker, director general of the Association of the British Pharmaceutical Industry, said he thought it was right that Nice should no longer be able to accept or reject a drug for the NHS. “It should be a clinical decision on what medicine a patient needs, informed by a broader sense of value than the current one that Nice applies,” he said.

He envisaged that Nice would continue to look at the effectiveness of a medicine and give advice, but then the drug manufacturer would meet with the NHS to discuss the price. “We believe a more productive way forward based on some kind of broad assessment of value is for the company to sit down and discuss the outcome of that with the department of health and the NHS, rather than have another body set up. We don’t think there is a disagreement between us [the industry and the government],” he said.

Value-based pricing would replace the current complicated system known as the PPRS (pharmaceutical price regulation scheme), which reimburses companies for the drugs they supply to the NHS. The industry has defended the PPRS in the past, but Barker said he thought it would support the new system – as long as existing barriers were swept away.

At the moment, there are some regional bodies assessing the usefulness of medicines and PCTs have pharmacy advisers and formularies – lists of drugs they are willing to buy – which the industry hopes will all go.

From: http://www.guardian.co.uk/nice-to-lose-new-drug-power

Hundreds of thousands of patients in the early stages of Alzheimer’s disease could get drug treatments following a U turn by the killer quango NICE.
Having banned the use of Alzheimers drugs for several years the National Institute for Curbing Expenditure (NICE), now says the evidence backs the use of drugs for “mild” symptoms.

Current rules prevent NHS doctors prescribing donepezil, galantamine and rivastigmine in such early cases.

Campaigners said the release of the new draft guidance was a “momentous day”.

As many as 465,000 people in the UK have Alzheimer’s disease, and this is expected to rise as the population ages.

The availability of drugs for the condition on the NHS has been source of controversy for almost a decade.

While there has always been evidence they diminished the symptoms and boosted quality of life for some, it has not always been clear exactly how much improvement they could deliver, to which groups of patients, and for how long.

In 2005, killer quango drugs watchdog NICE ruled that no-one should get the drugs on the NHS, then conceded a year later that patients with “moderate” disease should receive them, while still ruling out “mild” patients.

The secret formula used by NICE to calculate how much “value for money” the drugs offer to the NHS was then the subject of a court action by the Alzheimer’s Society and pharmaceutical companies.

* 2005 Draft NICE guidance recommends no patients should receive Aricept (donepezil), Reminyl (galantamine) or Exelon (rivastigmine)
* May 2006 Final guidance says those with moderate Alzheimer’s are eligible, but not those with mild disease
* October 2006 Internal NICE panel rejects appeals over decision to exclude “mild” patients
* June 2007 High Court backs NICE decision following Judicial Review
* May 2008 Court of Appeal rules NICE should make public their “economic model” which calculates the financial benefits of a drug
* June 2009 NICE admits “technical inaccuracies” in the model, amends it, but does not alter guidance
* October 2010 Five years on, a fresh review of the guidance backs prescribing three drugs for mild Alzheimer’s, and includes a fourth for more advanced disease

After the case went all the way to the House of Lords, NICE was forced to first disclose the formula, then amend it after admitting “technical inaccuracies”, although it said this did not change the outcome.

That new review now proposes giving the drugs to patients with mild symptoms – which covers people in the early stages of the disease, perhaps suffering memory loss and confusion, but not yet dependent on carers for day-to-day activities.

It has also suggested a fourth drug, Ebixa, be made available for the first time to patients with more advanced disease.

The guidance is still subject to appeal by the quango.

Ruth Sutherland, the interim chief executive of the Alzheimer’s Society, said that it was “a momentous day”, with approximately half of the 62,000 people who develop the disease every year likely to benefit from the drugs.

She said that the drugs, which cost approximately £2.80 per person per day, were not a “miracle cure”, but made important differences to people’s lives.

She said: “For the price of a cup of coffee they can mean the difference between recognising your loved ones and playing with your grandchildren.

“It is critical that this draft decision becomes a reality and that all people with Alzheimer’s are given the opportunity to benefit.”

The society’s Director of Research, Professor Clive Ballard, said: “If this guidance is issued, doctors will no longer have to watch people deteriorate without being able to treat them.”

Professor Roy Jones, from the Research Institute for the Care of Older People in Bath, described the decision as “an important milestone”.

He said: “Early diagnosis and access to medication is critical to help reduce both the short and long-term impact of this devastating condition on patients, families and carers.”

From: http://www.bbc.co.uk/news/health-11486367

Having wasted a few reports recently on extending the nanny state by battering voters into not eating fat food the killer quango NICE has now decided to prematurely kill cancer patients.
Kidney cancer patients will not be allowed a new drug that could extend their lives by up to three months because it is too expensive, the NHS drug rationing body has said.

The National Institute for Curbing Expenditure has turned down the drug called everolimus, also known as Afinitor, saying it does not offer enough benefit to patients to justify the cost.

Each pack of the drug costs £2,822 and the manufacturer, Novartis, had offered the first pack free to the NHS and a five per cent discount on following ones.

But even with this, and taking into account new guidance on end of life drugs which allows Nice to approve more expensive drugs that extend life for patients with rare diseases, the treatment was still too expensive, the panel decided.

An estimated eight week cycle of treatment would cost £5,264 per patient.

The cost per quality adjusted life year gained, a complex calculation taking into account improvement in quality of life as well as extra length of life versus the cost of the new drug over and above existing treatments, is almost double what Nice would normally allow.

Around 4,000 people a year in England and Wales are diagnosed with advanced kidney cancer and those who would be eligible for treatment because they had already tried the other drug, called Sutent, and were still fit enough to attempt another drug, would be much fewer, Nice said in a statement.

Patient groups hit out at the draft guidance saying people with rare cancers were being penalised.

Last year patients with advanced kidney cancer campaigned after four drugs including Sutent were turned down. Nice partially reversed the decision and Sutent is now available.

Mike Hobday, Head of Policy at Macmillan Cancer Support, said: “We are disappointed by Nice’s decision not to make everolimus available on the NHS for people living with advanced kidney cancer, who already have limited treatment options following the rejection of three clinically effective drugs last year.”

“It’s unfair that patients suffering from rarer cancers are repeatedly denied treatments that could extend their lives. Drugs like everolimus can dramatically improve people’s quality of life. They can mean the difference between patients being given a few weeks to live and a few months – valuable time that can be spent with family and friends, which means a lot to cancer patients.”

Nick Turkentine, Chief Operating Officer for the James Whale Fund for Kidney Cancer said: “Once again Nice has disappointed the thousands of kidney cancer sufferers in the UK by not approving everolimus, a drug which gives terminal kidney cancer patients and their families some hope.”

From: http://www.telegraph.co.uk/Kidney-cancer-patients-denied-drug-that-can-extend-their-lives

Cutting the average consumption of salt from eight grams a day to three would save up to 20,000 lives year and reducing fat would save even more, new guidelines  from the killer quango pontificates.Sweeping changes in food production, government policy and lifestyle could prevent tens of thousands of unnecessary deaths each year in Britain and save billions for the economy, the National Institute for Curbing Expenditure has said in new guidance.

Food producers should cut the amount of saturated fat in food and eliminate all ‘toxic’ artificial fats, called trans fats, completely.

Trans fats are added to food to prolong shelf life, have no nutritional value and have been linked to heart disease.

Ministers should consider introducing legislation if action is not forthcoming by manufacturers, the guidance said.

The average person in Britain consumes more than eight grams of salt a day where as the body only requires one gram to function. Targets are already in place to reduce consumption to six grams by 2015 and this should be extended to three grams by 2050, the guidance said.

Children should consume considerably less salt than adults and because the bulk of salt in the diet comes from prepared food, such as bread, cereal, soups, meat and cheese products, manufacturers have a key part to play, the guidance said.

The guidance, drawn from evidence of beneficial measures, was commissioned by the Department of Health and covers population based measures rather than advice for individuals. It calls for action from a range of public bodies, business and Europe, but is not binding.

There are around five million people living with the effects of cardiovascular disease, which includes heart attacks, heart disease and stroke. There are around 150,000 deaths each year and while mortality rates have fallen, there are 300,000 new cases diagnosed each year in Britain.

The Nice panel has calculated that 40,000 deaths a year could be prevented by significant reductions in salt and saturated fat consumption and if all trans fats were eliminated from prepared foods.

The guidance has called for a wide range of measures including:

– Low salt and fat foods should be sold more cheaply than their unhealthy counterparts, through the use of subsidies if necessary, although the guidance stopped short of calling for a ‘fat tax’ on high salt and fat foods saying this was difficult to implement.

– Advertising of unhealthy foods to children should be banned until after 9pm and planning laws should be used to restrict the numbers of fast food outlets, especially near schools.

– The Common Agricultural Policy should focus more on public health with farmers paid to produce healthier foods.

– Action should also be taken to introduce a traffic light food labelling system, the Nice panel said, even though the European Parliament recently voted this down.

– Local authorities must also act to encourage walking and cycling in their areas and public sector caterers must provide healthier meals as has already been seen in schools, the guidance said.

– All lobbying of government and its agencies by the food and drink industry should be fully disclosed.

Professor Klim McPherson, Chairman of the Nice Guidance Development Group and professor of epidemiology at Oxford University, said: “The guidance sets out a range of evidence-based recommendations for effective action to help reduce CVD levels.

“Where food is concerned, we want the healthy choice to be the easy choice. Going even further, we want the healthy choice to be the less expensive, more attractive choice. Just one of the recommendations is reducing saturated fats and removing trans fats from the diet – this can save over 20,000 lives every year.

“Put simply, this guidance can help the Government and the food industry to take action to prevent huge numbers of unnecessary deaths and illnesses caused by heart disease and stroke.”

From:
http://www.telegraph.co.uk/Ban-bad-fats-and-cut-salt-to-save-40000-lives-a-year-says-Nice

The NHS needs a new body for evaluating diagnostic tests if it is to make the most of advances in genomic medicine, says a report.
The PHG Foundation and the Centre for Science and Policy at the University of Cambridge say that the potential of genetic testing to deliver better treatments at lower cost will be delayed unless there is a system to establish the benefits.

The absence of such a system means that hospitals and GPs may waste money on new tests that do not have clear benefits for patients, while ignoring others that can lead to better clinical outcomes. Just as the National Institute for Health and Clinical Excellence (NICE) currently recommends which treatments are cost-effective for NHS use, new genetic diagnostic techniques must be examined in a methodical way.

“The Department of Health should establish an evaluation and decision-making body, as a matter of urgency, to direct research funding towards important strategic questions and ensure evidence-based implementation of both new diagnostic techniques and informatics systems within the NHS,” the report says.

The recommendation comes in response to a House of Lords inquiry into genomic medicine published last summer, which found that the NHS was not ready to take advantage of genetic advances in healthcare.

The falling costs of reading DNA mean that it is likely to be possible to sequence any person’s entire genome for less than £1,000 within a year or two.

Scientists have also started to identify how variations in DNA affect responses to drugs or susceptibility to disease, raising the prospect of personalised medicine based on individuals’ genetic profiles.

Doctors could potentially use genetic information to select the best drugs for treating particular patients, or to calibrate doses of medicines with potentially dangerous side-effects, such as the blood-thinning drug warfarin. Companies such as 23andMe and Pathway Genomics are already selling genetic tests directly to consumers that provide some of this information.

Little research, however, has so far shown that knowing details of a patient’s genome is helpful to doctors, and leads to better medical outcomes when it is used in prescribing drugs.

The new report, which was compiled following four seminars attended by more than 50 doctors, scientists, ethicists and patient representatives, says that this needs to be addressed as new genetic tests are offered to the NHS.

NICE recently established a diagnostics assessment programme to start this, and is currently conducting a pilot project, but a more comprehensive system is needed. New commissioning structures are also required to ensure that validated tests are accessible everywhere.

Caroline Wright, head of science at the PHG Foundation, said: “The heart of the problem is that we do not have enough data on whether these tests actually help patient care. We desperately need the equivalent of clinical trials for diagnostics.

“There’s an implicit assumption that testing is good, that knowledge is power, but the key question is does a test result helpfully change the management of a patient? If not, it is a waste of money.

“When public money is being spent, it must be spent sensibly to get better care outcomes. It’s really important that anything funded by health systems has evidence behind it.”

From: http://www.timesonline.co.uk/tol/news/science/genetics/article7128357.ece

The National Institute for Curbing Expenditure (NICE) wants to set a minimum price for a unit of alcohol in its latest wheeze to crack down on problem drinking.
The public health quango, which labour set up as the Government’s drugs rationing body, has spent two years looking at how to reduce alcohol-related health problems.

One in four people drink at levels that could be putting their physical and mental health at risk, according to official figures.

The move will reignite debate about how best to deal with the problem.

Deaths from alcohol abuse have more than doubled in the last 16 years, with almost 9,000 a year now succumbing to conditions such as alcohol poisoning and liver cirrhosis

More than 860,000 people a year are also admitted to hospital because of alcohol and the cost to the nation of excessive drinking is put at an estimated £27 billion a year.

Health experts and charities have all backed calls for a minimum price per unit to curb Britain’s binge drinking culture.

But many in the drinks and retail industries are strongly opposed to such a move and believe a minimum price would disproportionately hit responsible drinkers.

The move has already been backed by the British Medical Association (BMA) and the Royal College of Physicians.

Analysis by Sheffield University found that setting a minimum price of 50p a unit would save up to 3,400 lives a year without hitting moderate drinkers.

A draft of the Nice guidance, published in October last year, recommended the introduction of a minimum price per unit and said there was “sufficient evidence … to justify the introduction of a minimum price per unit.”

As well as overall consumption levels, a minimum price would also help to reduce binge and underage drinking, advocates believe.

Minimum pricing is expected to have a much harder impact on supermarkets and off licenses than pubs and restaurants, which sell alcohol at higher prices.

Supermarkets in particular have been criticised for selling alcohol at very low prices, including cans of beer for as little as 22p each.

The Wine and Spirit Trade Association said that minimum pricing “would punish millions of innocent consumers” without solving the problem of alcohol misuse.

From: http://www.telegraph.co.uk/Minimum-price-for-alcohol-to-be-backed-by-Nice

Hundreds of cancer patients may have been left to die without access to life prolonging medication, despite the drugs being approved by the labour government.

A postcode lottery means hundreds of people are missing out on life-prolonging care

Now figures obtained under the Freedom of Information Act show that a cancer patient’s chances of overruling health authorities who deny them access to drugs depends on where they live.

Some NHS trusts, such as Torbay in Devon and Salford in Manchester, granted all appeals while in others, such as Kingston in southwest London, only 7% were granted. In about one-third of trusts, fewer than half of the requests for drugs that can cost thousands of pounds a month were approved.

Access to cancer drugs has become an election issue, with the Conservatives saying they will ensure the National Health Service directs £200m more into supplying new drugs. The money will come from what the health service would otherwise have had to pay to meet Labour’s hike in National Insurance, which the Tories have said they would partially reverse.

The drugs concerned have all been approved by the labour government’s National Institute for Curbing Expenditure (Nice). However, each of 152 primary care trusts (PCTs) in England is allowed to use its own interpretation of Nice’s regulations.

In some cases patients who have already had two courses of chemotherapy are not allowed the drugs; in other cases they must have tried cheaper alternatives before being eligible. Those who do not meet the conditions must appeal to an “exceptional case” panel.

Widespread variation in attitudes between health trusts emerged in research to be published in Health Insurance magazine. It asked how many “exceptional-case funding requests” for cancer were received by trusts in 2009.

It named five drugs, including Rituxan for leukaemia; Tarceva for lung cancer treatment and Revamid for blood cancer.

All such appeals were granted by 17 healthcare trusts, with the areas benefiting ranging from Walsall and Manchester, to Torbay and Suffolk. However, Kingston and Northamptonshire refused most of the appeals made to them.

Forty one of 122 primary care trusts that responded granted fewer than half requests. The figures present an incomplete picture because some trusts may prescribe medicines without the need for patients to appeal. Critics, however, say they still show unacceptably wide variations in practice.

Specialists also complain that the NHS trust officials who decide whether or not to grant the appeals are rarely experts in the disease, so they help to create the wide discrepancies.

Karol Sikora, a cancer specialist at Hammersmith hospital, west London, said his department has a wallchart that marks both sympathetic and unhelpful PCTs. “You find yourself talking to office temps and all sorts of unlikely people who are apparently making these life-or-death decisions,” said Sikora.