What could make the cost of new cancer drugs cheaper? In the latest Lancer Oncology, NICE has some suggestions.
1. Recent proposals by an international group of academic clinical investigators suggest that clinical trial costs could be decreased by 40–60% without detriment to their quality. (EL Eisenstein, PW Lemons and BE Tardiff, et al. Reducing the costs of phase III cardiovascular trials. Am Heart J, 149 (2005), pp. 482–488. EL Eisenstein, R Collins and BS Cracknell, et al. Sensible approaches for reducing clinical trial costs. Clin Trials, 5 (2008), pp. 75–84.)
2 Simple measures to reduce costs include electronic data capture, reduction in the length of case-management forms, and modified site-management practices. The latter should include greater use of statistical techniques to detect fraud, rather than over-reliance on site visits by regulators and sponsors.
3 Greater use of Bayesian techniques in the design and analysis of randomised controlled trials holds real promise in reducing trial duration and numbers of patients needed.
4 Oncologists and patient advocacy organisations should start challenging the data requirements demanded by regulatory authorities.
5 Rather than criticise organisations such as NICE for declining reimbursement on grounds of cost-effectiveness, clinicians and patient advocates should start challenging pharmaceutical companies about the high prices they seek for products with modest benefits.
6 We should all be more concerned about the difficulties facing low and middle income countries in accessing affordable cancer care, rather than constantly focusing on the problems facing developed countries.