New treatments for advanced cancer: an approach to prioritization

Abstract

The allocation of funding for new anticancer treatments within the UK has not kept pace with demand. Clinicians find themselves restricted in the use of licensed drugs which they feel are in the best interests of individual patients. Against this, health authorities have a duty to ensure that scarce resources are used equitably to meet the needs of the local population as a whole. Differential levels of funding for new treatments across the country have led to concerns about rationing by postcode. This paper outlines an approach to the prioritization of new treatment for advanced cancer developed jointly by clinicians and health authorities in South London. The approach involves evidence reviews and consensus meetings. Existing and new treatments are rated on a four-point ‘relative effectiveness scale’, which takes account of the impact of the treatment on quality of life and on survival. The strength of evidence supporting each effectiveness rating is also classified. Health Authorities have used these ratings to determine overall funding levels, while leaving decisions on individual patients to the relevant Trusts. © 2000 Cancer Research Campaign

New Chemotherapy Treatments in Advanced Cancer Patients An Easily Applicable Evaluation of Clinical Efficacy and Cost–effectiveness

“…'/, significant difference; *, not comparative studies and studies with explicit measurement of quality of life. 1 Scale taken from Ferguson (see Table 2 and reference 1).…”

“…Importantly, it should be presented in a form that we can use when making clinical decisions. In short, we need economic data that can be incorporated into our clinical practice (1,15). The definition of cost-effectiveness thresholds has always been a controversial issue and remains a matter of debate.…”

“…Outcome evaluation: efficacy and strength of evidence scales ( Table 2) Our assessments of the efficacy of the treatment regimens and the quality of evidence supporting them were based on the four-point (A Á/D) efficacy (E) and five-point (1 Á/5) strength of evidence (SE) scales proposed by Ferguson et al (1). We modified the latter scale, because of the scarcity of meta-analyses for drugs of such recent introduction.…”

“…The past few years have seen rapid changes in the treatment of locally advanced and metastatic cancer patients, largely due to the approval and incorporation into clinical practice of numerous new drugs that have shown promising results in preliminary investigations (1). Many of these new molecules have been derived from recent advances in our understanding of cancer biology, drug resistance mechanisms and pharmacodynamics.…”

“…The choice of a treatment must be based on: the degree of certainty that it will yield a benefit, conditioned by the quality of supporting studies; the magnitude of this benefit (the efficacy and effectiveness); and the economic costs it generates (1,11). There appears to be a consensus that treatments should produce an incremental survival of at least 3 Á/4 months in at least 20% of patients treated, and that the quality of life (QoL) of patients should be improved or not worsened (3,12).…”