Variation has reduced in use of NICE-approved cancer drugs
Variations in the use of cancer drugs approved by the National Institute for Health and Clinical Excellence are reducing, according to a review carried out by the national cancer director, Mike Richards, published by the Department of Health recently.
As its baseline, the review used a study conducted between July and December
2003, which showed that, although overall use of cancer drugs generally
increased after a positive NICE appraisal, considerable variation in
the use of drugs remained between the 34 cancer networks in England.
The latest study, carried out between January and June 2005, showed that
variation had reduced by a minimum of 9 per cent (for capecitabine) and
a maximum of 62 per cent (for vinorelbine). The median percentage increase
in the uptake of cancer drugs
following positive NICE guidance between the two review periods ranged
from 11 per cent for vinorelbine and fludarabine to 120 per cent for
temozolomide.
The reviewer states that he would like to see variations further reduced,
but makes it clear that differences in uptake will remain. For example,
some patients are referred to another network for more specialist treatment.
In the report, cancer networks are advised to use a web-based capacity
planning tool that has been developed by the Pharmaceutical Oncology
Initiative Partnership, a joint venture between the Association of the
British Pharmaceutical Industry, the DoH’s Cancer Action Team and
the NHS Cancer Services Collaborative. According to Marie Palmer, from
the NHS CSC, the roll out process for the tool has started, with expert
trainers from Scotland and from six cancer networks in England recently
being briefed on its application.
Planning ahead and being aware of drugs under development is another
of the main recommendations the report makes to cancer networks. This
is because the NICE appraisal process has been speeded up, so new cancer
drugs could potentially be approved within weeks of becoming licensed.
Other recommendations include the use of more local interim solutions
for oncology
e-prescribing, before the national strategic e-prescribing solutions
are deployed (between 2008 and 2010).
Libby Hardy, lead pharmacist for Peninsula Cancer Network, said that
the report shows that the “action plans provided by those networks
[previously] showing under-use have been successful”. However,
she added that there are some limitations in the accuracy of the data
collected. For example, it does not confirm that the drugs were used
for their NICE indication only, and use by home care providers potentially
causes distortions. Once e-prescribing is in place, more accurate data
on the use of all chemotherapy drugs should be available, she added.
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Hospital Pharmacist