EXCLUSIVE: Health Insurance reveals cancer drug postcode lottery

3. NICE may have approved the drug but their doctor may wish to use it outside the terms of this guidance NICE guidance will either approve a drug for use on the NHS or decline it. However, the approval is also subject to certain criteria being met. For example, it will be approved for a certain type of cancer and perhaps only for patients whose cancer has progressed to a certain point. If a doctor wants to give the drug to a patient who falls outside this criteria they may need to appeal to the PCT in order to secure funding.

1. Written request to PCT, usually made by specialist or GP on patient’s behalf

2. PCT confirms application received and date for hearing

3. Decision made by panel of PCT board members – patient and doctor may be permitted to attend

4. Decision made within set period of time (usually four to eight weeks, but can be much quicker for urgent cases)

5. Patient and doctor receives written decision

6. If request denied an appeal can be made (usually must be made within 28 days)

Sorafenib is a drug which can be used to treat advanced liver cancer. In November 2009 NICE issued draft guidance on using sorafenib in patients for whom surgery or therapies in the region where the cancer arose have failed or are not suitable. At this time it did NOT recommend the drug. The chief executive of NICE, Andrew Dillon, said that it did not provide enough benefit to patients to justify its high cost and that NHS money could be spent on “better value” cancer treatments.

Final guidance is expected to be published this year. In the meantime, PCTs have been told to make decisions locally. Health Insurance research shows that while some are approving the use of sorafenib for the treatment of liver cancer, others are not. In 2009:

Camden and Hertfordshire both rejected four requests

Bromley rejected two requests

Coventry, Brighton & Hove and Manchester all rejected a request

Northamptonshire, Stockport, Redbridge and Torbay Care Trust each approved a request

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