301 Health Economics

Question 1

What is the cancer drug fund (CDF)?

Answer 1

Government-providing funding source in England for cancer drugs
- Faster access to promising treatments
- Value for taxpayer’s money
- A fast-track route for pharmaceutical companies pricing their products responsibly

Question 2

What are the types of health models?

Answer 2

Biomedical, WHO definition (1948), biopsychosocial Engel 1977, sociological, multifactorial, guideline

Question 3

What are the factors of multifactorial model of health?

Answer 3

Sexual, physical, mental, emotional, spiritual and social

Question 4

What are the evidence based guidelines?

Answer 4

Population based not individuals
Cost-effectiveness
Lifestyle interventions
Single conditions and pathways

Question 5

What are the deontology views of healthcare?

Answer 5

Duty of care to individual
Rule based
Care for individual is without reference to impact on society

Question 5

What are the utilitarian views of healthcare?

Answer 5

The end justifies the means
Greatest benefit
May lead to harm to some individuals

Question 6

What are the undercurrents of health economics?

Answer 6

1. Business side of pharmaceutical industry
2. Free NHS
3. Personal responsibility
4. Screening as a pragmatic approach - need to understand specificity and sensitivity

Question 7

What is the currency of health?

Answer 7

Quality Adjusted Life Year (QALY)
1 year of life in perfect health
Ability to carry out daily activities, freedom from pain, mental disturbance

Question 8

What are DALYs?

Answer 8

Disability Adjusted Life Years
Measures burden of disease

Question 9

Who applies for CDF funding on behalf of a patient?

Answer 9

A consultant applies through a “Blueteq” application

Question 10

Why was the previous CDF system deemed unsustainable?

Answer 10

• Over-approval of drugs led to unsustainable costs
• By 2015-16, fund overspent by £126 million (37% over budget)

Question 11

What was the budget for CDF in 2010 and how did it change by 2016?

Answer 11

Initial budget was £200 million and increased to £340 million by 2016

Question 12

What are the key features of the new CDF introduced in 2016?

Answer 12

• Part of NICE review process
• Aims to review all drugs within 90 days of licensing
• Includes reviews of drugs for rare cancers
• Provides clear entry & exit strategies for drugs
• Collects more data on drugs that show potential but lack firm evidence

Question 13

How does NICE categorise drugs under the new CDF?

Answer 13

NICE make 3 decisions:
1. Yes - available on NHS
2. No - unavailable on NHS
3. Maybe - available via CDF if drug meets value-for-money criteria, pharmaceutical company agree to CDF terms and data collection on efficacy is feasible

Question 14

How long can a drug remain on CDF list?

Answer 14

Generally 2 years

Question 15

Who is responsible for safety of drugs funded by CDF?

Answer 15

Medicines and healthcare products regulatory agency (MHRA) and European medicines agency (EMA)

Question 16

What role does NICE play in drug appraisals?

Answer 16

Evaluates clinical and cost-effectiveness of drugs but only for those with marketing authorisation or expected authorisation

Question 17

Drugs on the CDF may only be used in certain circumstances

Answer 17

• Depending on type of cancer
• Depending on cancer stage
• Only in advanced cancer
• Only if previous treatments tried

Question 18

What alternative funding exists in Scotland and Wales for new treatments?

Answer 18

“New treatment fund” for rare and life-limiting conditions, not limited to cancer

Question 19

Where can the CDF drug list be accessed?

Answer 19

NHS England website lists drugs eligible for CDF