For patients in Scotland suffering from pancreatic cancer, the decision by the Scottish Medicines Consortium (SMC) not to approve the use of the drug abraxane to treat the condition will be difficult and upsetting.
The drug has been shown to extend survival from pancreatic cancer, which is notoriously difficult to diagnose, by about two months on average. Two months is not a long time, but it is when it means two months more with friends and family. In an ideal world, the drug would go to every single patient.
However, the NHS in Scotland and the SMC have to operate in a less than ideal world where resources are limited and a balance has to be struck between the benefit to the patient and the cost to a healthcare system that is constantly under financial strain. In the case of abraxane, the SMC has said the use of the drug would not be cost-effective (the full course of treatment is £8,856 per person).
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This is a tough call to make and it is hard not to feel sympathetic towards the reaction of pancreatic cancer charities that have greeted the SMC decision with dismay. After all, this is not an obscure, rare condition; it is the fifth most common cancer in Scotland and it is likely to become more common in an ageing population. The hundreds of people who are diagnosed every year with pancreatic cancer and their families will directly feel the effect of this decision.
The decision is also hard to accept when compared to England, where abraxane is available to patients thanks to the Cancer Drugs Fund, which was set up by the Coalition Government in 2011 to help patients secure access to certain drugs before they get approval for widespread NHS use. The fund has since gone on to help patients south of the Border access drugs that have not been available in Scotland, although the NHS in England is not immune from the pressures in Scotland and the fund is due to come to an end within two years.
In response to the SMC decision on abraxane, the Scottish Government has also rightly pointed out that it has reformed the way in which the NHS accesses new drugs in Scotland, which had been lagging behind other parts of the UK. The improvements include a new transparency to the meetings of the SMC that are now held in public and reform of the criteria the consortium uses to make its decisions. It is to be hoped the manufacturers of abraxane will resubmit under this new process and that a different outcome will be possible.
However, even if the reforms prove efficacious and even if abraxane is approved in due course, the SMC will always have to make difficult decisions on which drugs to pay for. Some patients will lose out in that process, but others will gain when the money that would have been spent on expensive new drugs is instead spent on hip replacements, cataract operations or other less expensive procedures. It is undoubtedly right that the process of approving new medicines is more open and it is right that it is subject to scrutiny, but a process of balancing of priorities will always have to exist in the NHS for the benefit of as many patients as possible.