Why Cancer?

Throughout my career as a health economist, one issue has always been a mystery to me—why does cancer enjoy such a dominant position within healthcare systems throughout the world? The debate concerning the reconfiguration of the Cancer Drugs Fund (CDF), which is addressed in this journal [1], represents a microcosm of a much wider debate reflecting the complex and ever-changing interface between political expediency and clinical rationality within health services internationally. Within the UK National Health Service (NHS), the CDF has been the subject of controversy since its inception because it creates a ‘backdoor’ to healthcare funding that circumvents health technology assessment (HTA) programmes in the UK and is only available for cancer drugs. The existence of a more favourable funding mechanism solely dedicated to extending the use of cancer drugs (irrespective of their clinical and cost effectiveness) represents a major health policy issue as it introduces significant inequalities into a UK system that was founded on the premise of providing equal access to patients in equal need. The very existence of the CDF is contrary to this founding principle as it creates a two-tier definition of ‘need’—one for cancer and one for patients from every other therapeutic area. Such a fundamental realignment of health service principles in favour of cancer patients inevitably imposes significant ethical, economic and health implications as a direct consequence of this inequity, which is now built into the funding basis of the NHS. It is important to acknowledge that the funding of any individual drug may be justified by a range of factors beyond its cost effectiveness, such as considerations of unmet clinical need, innovation or equity. Such factors are already considered on an individual basis as an integral part of the UK National Institute for Health and Care Excellence (NICE) appraisal process, and it is difficult to comprehend why such factors should be of particular relevance in the case of cancer drugs. However, surely society should be able to prioritise its structure of healthcare provision in whatever manner it wishes, and if ‘society’ makes an informed judgement that it wishes to ‘overfund’ treatments for cancer, then so be it! Although this may be a realistic representation of the political reality, I remain unconvinced that ‘society’ is truly aware of the opportunity cost imposed on non-oncology patients as a direct consequence of the CDF and similar ‘onco-favouring’ policies. It is important to continuously remind ourselves and others of one key fact: the very existence of a more generous funding stream for cancer drugs inherently takes us into a ‘second best’ world, which is an affront to our commitment as health economists to the concepts of both efficiency and equity. To return to our Panglossian vision of the ‘best of all possible worlds’ would simply require the additional NHS funding allocated to the CDF to be made accessible to all therapeutic areas. This would ensure that such resources would be allocated purely on the basis of incremental patient benefit rather than therapeutic favouritism. In this regard, I must admit that one further fact mystifies me. I fail to understand the apparent unwillingness of clinicians from other therapeutic areas to effectively This comment refers to the article available at doi:10.1007/s40273016-0403-2.