[HarryHirsch]

There was political pressure on the NHS a few years back to say "yes" more often. This led to the introduction of the Cancer Drugs Fund to increase access to unproven cancer treatments. The disaster was as big as everyone predicted: a billion spent with nearly no clinical benefit. They should have listened to the bureaucrats at NICE.

Aggarval et al. have the data: https://www.ncbi.nlm.nih.gov/pubmed/28453615

[refurb]

Unproven? There were plenty of proven cancer drugs the NHS said “no” to, not because there was no data, but because they said the cost wasn’t worth it. You’ll live another 6 months? No we won’t pay $50K for that.

[derekp7]

That actually makes a lot of sense, in that if there is a limited amount of funding then that 50K should go to a treatment that will give someone another 10 years. Under the US system, private insurance is just as quick (if not quicker) to deny that treatment.

Of course, under either system, if you come up with the 50K, then the treatment is all yours.

[ed_elliott_asc]

I’ve lived through a cancer and dragging it out for another 6 months doesn’t help anyone.

[refurb]

As someone who has worked in the US system, private insurers often pay for treatment quite quickly after approval. Unless the evidence is quite shaky, it’s usually paid for.

Now whether that’s a good thing is a separate question.

[rayiner]

> Under the US system, private insurance is just as quick (if not quicker) to deny that treatment.

It’s hard to find data on this, but I haven’t seen any basis for concluding that private insurers are “just as quick” to deny treatment. In the past, private insurers tended to have lifetime limits. They’d let you blow through the lifetime limit, and then deny care. In the NHS, the cost benefit of care was more carefully scrutinized from the outset. There is a lot of coverage of the NHS denying hip replacements and cataracts surgery, which is almost universally covered in the US: http://www.telegraph.co.uk/science/2016/04/27/hip-replacemen.... The US also does quite a bit better in cancer survival rates, suggesting that insurers aren’t just denying treatment to cancer patients: https://qz.com/397419/the-british-seem-less-likely-to-get-ca....

The ACA eliminated lifetime limits, but also limited insurer profits to 20% of expenditures. So now, insurers really have no reason to deny care.

[HarryHirsch]

Cancer survival rate is tricky but probably explained by better screening in the US: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706735/

The hip replacement issue is known as the "little old lady problem" in NHS circles. Hip replacement is not urgent, you'd like to concentrate the limited funds where lives are at risk. Unfortunately, little old ladies are fodder to enemies of public healthcare and always rolled out in this context.

[DanBC]

Cancer survival rate uses "5 year survival rate".

Take every man over the age of 50 and then give them prostate screening, and then don't do anything else at all. Don't test any of the prostate cancer that you find.

Your 5 year cancer survival rates go up, because most prostate cancer is slow growing.

But this situation isn't what happens. The US screens a bunch of men, and then treats the cancer they find. Does this reduce all cause mortality?

No.

https://www.harding-center.mpg.de/en/fact-boxes/early-detect...

This is what people in the American system pay for: testing and treatment that causes harm and which doesn't prevent death.

[JamesBarney]

It's my understanding is the U.S. is especially aggressive with screenings, which might have some impact on % of cancer deaths, but has an even larger impact on cancer survival rates.

Ex. If a cancer will kill you in 5 years and there is no treatment. Catching it year 2 vs 3 will prolong your lifespan 50%.

[DanBC]

A complete misrepresentation of what happened.

People didn't live longer, many of them died sooner, and most of them had pretty severe side effects.

https://www.bmj.com/content/357/bmj.j2097

> The Cancer Drugs Fund (CDF) has not “delivered meaningful value” to patients with cancer and may have exposed them to “toxic side effects of drugs,” an analysis has found.1

> The CDF was established in 2010 in England to provide “patients with faster access to the most promising new cancer treatments” and to ensure “value for money for taxpayers.” It funded drugs that were not available through the NHS because the drugs had not been appraised, were in the process of being appraised, or had been appraised but not recommended by the National Institute for Health and Care Excellence (NICE). The fund was overhauled last year.