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Dasatinib Funding in the NHS

On 2 May below, I said I would post when I had a reply from NICE as to its attitude to Dasatinib. The reply I have received is as follows (with parts of it highlighted in bold by me):

"Many thanks for contacting NICE.

NICE has not yet been asked to look at dasatinib. NICE is asked by the Department of Health to look at particular drugs and devices where the availability of the drug or device varies across England and Wales, or where there is confusion or uncertainty over the value of a drug or device. To end this uncertainty, NICE makes a national decision over its use.

There is no ban on prescribing licensed drugs that have not yet been looked at by NICE or where a NICE appraisal is in progress. The Department of Health have issued clear instructions to the NHS that in the absence of NICE guidance, or whilst guidance is being developed, local organisations such as Primary Care Trusts and NHS Trusts) are expected to make their own assessment of available evidence before deciding how and if to fund the drug locally.

The Department of Health has made it clear that funding for newly licensed treatments should not be withheld because guidance from NICE is unavailable. In these circumstances, the Department of Health expects primary care trusts (PCTs) to take full account of the available evidence when reaching their funding decisions, (Rosie Winterton, Minister of State for Health - Commons Hansard, June 7 2005, Column 426W......"

So, in short, nothing has been referred to NICE in relation to Dasatinib. Each Primary Care Trust is required by the Department of Health to make its own assessment of Dasatinib in deciding whether or not to fund it. As with some other cancer drugs recently, this guidance from the Department of Health is tantamount to an invitation to some PCTs to fund Dasatinib and others to refuse to fund it - another post code lottery. That is a shocking and horrible position for CML patients with a life threatening illness and a very real problem for their consultants. It is particularly hard to understand if it is happenning to anyone who has been on 800mg of Glivec and needs to move to Dasatinib because that move in drugs should be less costly to the PCT.

Can I echo Elizabeth and Sandy's request for anyone with this funding problem to contact this Forum with some detail about their experience? Has anyone with this funding problem asked their PCT for a copy of the assessment that the PCT should have made in accordance with the Department of Health guidance above?

David

Interestingly, public funding for Dasatinib is now agreed in Scotland, but NOT as yet the rest of the UK.

I think, in these post devolution days, we are going to see an increasing number of funding issues between the various uk nations.
Another example is that in Wales all NHS prescriptions are now available free. This only applies to people living in Wales who have been prescribed medication by a GP in Wales (There are exceptions for patients living on the border of Wales/England)
Health funding is now the domain of the respective governments in the various nations which make up the UK. As a result it will be more difficult to present a 'united front' when making representation concerning funding of new drugs.
Of course NICE continues to be the government appointed body which reviews new treatments and makes recommendations to central government. However, the devolved governments can choose to overide the NICE decisions, as did the Welsh Assembly last year regarding Herceptin (a drug used in treating Breast Cancer) - funding was agreed in Wales before NICE announced their findings. This was largely due to a very effective campaign organised locally and which placed considerable pressure on the Welsh Assembly Government.
It will be interesting to see how people manage to obtain funding in the future.
Paul