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What can we do to decrease the cost of advanced cancer therapies and make them available for all?

By luis.lacerda, on 9 February 2024

There are 3 million people living with cancer in the UK, predicted to rise to 4 million by 2030[1]. Different societal groups are affected differently, in particular ethnic minorities who experience poorer outcomes[2]. Health inequalities are complex and their root causes diverse, including the fact that some cancers are more prevalent in specific communities[3]. Advanced research on targeted and personalised treatments can therefore bring hope to improve outcomes in the future and to “close the gap” in the access to cancer care. But how can these be made more affordable and included in holistic government strategies to manage cancer care?

Illustration of two people, two pill bottles and two DNA strandsAt UCL, the Future Targeted Healthcare Manufacturing Hub (FTHM Hub), which brings together academics, manufacturers, and policymakers, has been addressing manufacturing, business, and regulatory challenges to ensure that new targeted biological medicines can be developed quickly and manufactured at a cost affordable to society. This includes innovative research on the manufacture of promising cancer therapies ranging from Chimeric antigen receptor T-cell (CAR-T) therapies through to targeted drug therapies such as antibody-drug conjugates and cancer vaccines. The Hub engages with and supports several clinical groups at UCL that develop advanced therapy medicinal products (ATMPs), some of which have been commercialised or are being translated into the clinic.

The FTHM Hub’s work also includes more fundamental research into optimising manufacturing by innovating processes and finding new ways of reducing production costs of these therapies. Examples of this activity include manufacturing autologous CAR-T therapy at the patient’s bedside or in an automated “GMP-in-a box” system[4], which can bring about benefits in terms of cost reductions, accelerating bench-to-bedside innovation, and mitigate risks that are generated by market shortages[5].

The Hub has worked closely with healthcare specialists and regulatory authorities to analyse how CAR-Ts and other high-cost therapies affect NHS England’s ability to resource other health services. It has conducted detailed supply chain economics analysis to identify key cost of goods drivers for CAR-T therapies, supply chain optimisation, and to assess the risk-reward trade-offs between centralised and distributed manufacture.

The recent agreement reached between the Department of Health and Social Care (DHSC), NHS England and the Association of the British Pharmaceutical Industry (ABPI) on a voluntary scheme for branded medicines pricing, access and growth is a welcomed programme to explore how industry and government can better work to support the delivery of new advanced treatments for cancer, but this is not enough.

Furthermore, and for this important work to continue, investment and support on advanced manufacturing is required to understand possible implementation challenges of novel options such GMP-in-a-box in clinical settings. The new UK’s life sciences manufacturing funding to build resilience for future health emergencies is a good opportunity to do this to expand on the FTHM Hub’s work and ensure every patient living with cancer will have accessibility of treatment irrespective of geographical location.

In addition, time and cost of travel to specialised centres can pose an economic burden to patients and carers due to disparities in cancer care. New centres will also need dedicated staff to help deliver advanced therapies and the FTHM Hub is also training a new generation of professionals to enable rollout of those to patients.

In the week that marks World Cancer Day, the FTHM Hub continues to develop important work to treat patients with cancer and it is our hope at the Policy Impact Unit that we can work towards imagining new futures together, close the care gap, and bring better outcomes for all of those living with cancer.

 

References

[1] https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/11424-10061/Macmillan%20statistics%20fact%20sheet%20February%202023

[2] Martins, T., Abel, G., Ukoumunne, O.C. et al. Ethnic inequalities in routes to diagnosis of cancer: a population-based UK cohort study. Br J Cancer 127, 863–871 (2022). https://doi.org/10.1038/s41416-022-01847-x

[3] Delon, C., Brown, K.F., Payne, N.W.S. et al. Differences in cancer incidence by broad ethnic group in England, 2013–2017. Br J Cancer 126, 1765–1773 (2022). https://doi.org/10.1038/s41416-022-01718-5

[4] Pereira Chilima, T. & S. Farid. 2019. ‘A roadmap to successful commercialization of autologous CAR T-cell products with centralized and bedside manufacture.’ Cell Gene Therapies VI 73. Comisel, R. 2022. Decisional Tools for Supply Chain Economics of Cell and Gene Therapy Products. Diss. UCL (University College London).

[5] Bicudo, E. & I. Brass. 2023, ‘Advanced therapies, hospital exemptions & marketing authorizations: the UK’s emerging regulatory framework for point-of-care manufacture’ Cell and Gene Therapy Insights 9(1), 101-120.

Three shifts for improving the governance of emerging technologies

By Basil Mahfouz, on 11 June 2022

Without a coordinated global response, emerging technologies could quickly transform our world into a dystopia. By 2050, the lack of climate action may push mankind towards experimenting with planetary systems via geoengineering, lethal autonomous weapon systems could be deciding who lives and who doesn’t, while neuro-technologies will challenge the definition of what it means to be human.

To understand how to manage the societal impact of these technologies, on 16 May 2022, I joined 29 other specialists representing 21 countries at the Science Diplomacy Week Immersion Programme, a forum co-organised by the Geneva Science and Diplomacy Anticipator (GESDA) and the United Nations Institute for Training and Research.

The discussions highlighted that effectively governing frontier technologies requires three fundamental shifts across international science diplomacy: (1) adopting a proactive approach towards solving challenges, (2) leveraging cutting-edge computational tools, and (3) systemically scaling access to scientific knowledge.

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Moving on from Haldane: what are the challenges to steering STI for social and economic goals?

By joanna.chataway, on 10 February 2022

If anyone wants an overview of current S&T policy in the UK at the moment, you could do a lot worse than listening in to a recent discussion hosted by the Foundation of Science and Technology. Panellists were Sir Patrick Vallance, Chief Government Scientific Advisor and National Technology Adviser, Dame Ottoline Leyser, Chief Executive of UKRI, Naomi Weir, Programme Director, Innovation at the Confederation of British Industry and Professor James Wlisdon, Director of Research on Research, University of Sheffield. A fantastic lineup and a conversation that touched on many complexities of science, technology and innovation policy.  The importance of engineering policy was mentioned as part of the overall picture but much less was said about this, which is a pity[1].

Female lab researcher

Photo by Julia Koblitz on Unsplash

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Proposal for a ‘Net Zero What Works Centre’

By Siobhan Pipa, on 29 October 2021

From Professor Jeremy Watson CBE FREng

The legal requirement for the UK to achieve Net Zero greenhouse gas emissions by 2050 presents society with a wide-ranging and demanding set of challenges whose solutions require holistic and cohesive systems thinking across all sectors of activity. Social, technical, political and policy considerations must be taken together and solutions evolved that are driven by need, and which are applicable and acceptable for the whole of UK society. The November 2021 COP 26 meeting to be hosted by the UK, throws all this into sharp focus and suggests that government will wish to clearly demonstrate methods and pathways by which the 2050 objectives can be achieved. A Net Zero What Works Centre (NZWWC) may be an innovative and effective approach to accelerating and focusing coherent action.

Photo by Thomas Richter on Unsplash

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Is a total ban of plastic bags good and inclusive? Lessons from Rwanda

By katerynatsybenko, on 24 September 2021

In June 2021, Ukraine adopted a law to ban plastic bags. The ban will be implemented in stages: in December 2021, bags up to 50 microns thick will be banned; on March 2022, bags 15 microns thick will be banned. Only very small thin bags for transporting fish, meat, ice will be allowed but for a limited period of time. Starting from January 1 2023, only biodegradable bags will be allowed. Similar bans have been imposed in other countries, such as Rwanda and the UK, and in the EU. Radical policies to ban plastic bags may improve environmental sustainability, but there can be unintended consequences. They should be anticipated and carefully planned for.

plastic bags in different colours at lanfill

Photo by Brian Yurasits on Unsplash

The new Ukrainian law stipulates fines for using plastic bags: 1700-8500 UAH (45-215GBP, while 150GBP is a minimum salary) from December 2021, and 8500-34000 UAH (215-850 GBP) from March 2022.

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