1417PD - Nice technology appraisals and the uptake of breast cancer drugs in the UK

Date 01 October 2012
Event ESMO Congress 2012
Session Public health and familial cancer
Topics Bioethics, Legal, and Economic Issues
Breast Cancer
Presenter David Bertwistle
Authors D. Bertwistle1, P. Anderson2, M. Jofre-Bonet3
  • 1Health Economics & Outcomes Research, IMS Health, N1 9JY - London/UK
  • 2Swansea Centre For Health Economics, Swansea University, Swansea/UK
  • 3Department Of Economics, City University, London/UK




Health technology appraisal (HTA) recommendations from the UK National Institute of Health and Clinical Excellence (NICE) are intended to standardise health care throughout the NHS, and to hasten the uptake of new, more effective medicines that are cost-effective. Although it is compulsory for the NHS to fund drugs recommended by NICE, it is not clear how well NICE guidance is implemented. A number of studies have investigated whether NICE guidance influences UK drug uptake as intended. Most have used sales data, however, this approach has significant limitations. Sales data do not reveal which indication, line of therapy, nor patient sub-group a drug has been used to treat. Many drugs are licensed for multiple indications, and many HTAs only recommend the use of drugs in defined sub-groups, often subsets of the licensed indication. To avoid the limitations of sales data-based analyses, this study used IMS Health's Oncology AnalyzerTM as the primary data source. Oncology AnalyzerTM contains detailed records for a representative sample of patients, allowing analyses to be focussed on the particular indication and treatment criteria specified in NICE HTAs.


HTAs for breast cancer drugs appraised by NICE from 2005 to 2008 were analysed. For each HTA, the proportion of the eligible patient sub-group that received the recommended (or not recommended) drugs from Q1 2005 to Q1 2009 was determined. Changes in uptake of the drugs in the relevant patient populations were assessed for the UK, and were also compared to uptake in similar European countries.


NICE produced 6 HTAs for breast cancer, encompassing 8 drugs, during the period assessed. In 5 out of 6 cases, the publication of an HTA was followed by the recommended change in UK drug uptake. However, when UK uptake of drugs recommended by NICE was compared to uptake of the same drugs in four other European countries (France, Germany, Italy and Spain), the UK ranked at the bottom of the group.


The NICE HTAs assessed were mostly followed by the intended changes in drug uptake, suggesting they were implemented, at least by some PCTs. Despite this, international comparisons of uptake for these drugs revealed that the UK performed poorly compared to similar European countries.


D. Bertwistle: This research uses data from the IMS Health data asset, Oncology AnalyzerTM. I am an employee of IMS Health.

P. Anderson: This research uses data from the IMS Health data asset, Oncology AnalyzerTM. I am a former employee of IMS Health.

All other authors have declared no conflicts of interest.