Business

Editor: Bruce Meng
9 Oct 2008 01:46:29 GMT

LONDON, Oct 8 – Britain may soon allow top-up payments for costly cancer drugs within the state health service in a potentially divisive move highlighting the dilemmas facing cash-strapped social healthcare systems worldwide.

Mike Richards, the country’s National Cancer Director, is due to deliver a report into "co-payments" this month and is expected to say top-ups should be allowed in limited circumstances.

A government spokeswoman confirmed his proposals would come in October but declined to comment on the content.

Allowing top-up payments would be a jolt to Britain’s 60-year-old National Health Service (NHS), which currently prevents patients paying privately for treatment. Those seeking to pay are typically denied any free NHS care and critics fear allowing top-ups would introduce a two-tier service.

Yet top-ups offer a solution to cases where the National Institute for Health and Clinical Excellence (NICE) judges drugs not to be cost-effective, even though they may extend life.

The issue has come to a head in cancer, where modern targeted drugs offer improved outcomes over older chemotherapy — but at a cost of thousands of pounds a year.

The reluctance of the NHS to endorse many of these products has led to high-profile cases of terminally ill patients being denied free care after buying their drugs privately.

People familiar with the Richards’ review said he was likely to back some provision for top-ups while at the same time trying to make them the exception by recommending new mechanisms to bring down the cost of pioneering new drugs.

Drugmakers are watching warily.

Some companies, like Johnson & Johnson and Novartis, have already negotiated "risk-sharing" deals to cap the cost of their drugs to the NHS. But industry is cautious of making promises that could undermine prices in other markets.

Richard Barker, director general of the Association of the British Pharmaceutical Industry, said he would rather NICE looked again at a cost-effectiveness formula that has not changed in 10 years.

On the rare occasions where patients choose to co-pay for treatment, drugmakers argue they should be allowed to do so. But companies worry that a broad green light for top-ups could ratchet down medical care at a time of tightening state budgets.

"The last thing that the pharmaceutical industry wants is for patients to have to pay for these drugs themselves," Barker said. "There is no commercial enthusiasm for this."

New drugs have made cancer the fastest-growing section of the pharmaceuticals market, with global oncology sales predicted by IMS Health to increase at an average annual rate of 12 percent to 15 percent over the next five years, or double the overall market.

Britain — home to drug giants like GlaxoSmithKline and AstraZeneca — accounts for 3 percent to 4 percent of the world drugs market.