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Evidence from Genomic Health– MT 27

National Assembly for Wales Health and Social Care Committee inquiry

Access to medical technologies in Wales

Executive summary

· The NICE (National Institute for Health and Care Excellence) assessment programme that evaluates medical technologies for the NHS in England and Wales can be a lengthy process.

· Access to innovative medical technologies in Wales may be restricted by uncertainty around commissioning arrangements, pressures on NHS budgets, a culture of conservatism to emerging technologies and ageism in clinical decision-making.

· In order to ensure the timely adoption of effective new medical technologies, there should be a clear commissioning policy for those that have received NICE approval.

Introduction

1. Genomic Health® is the world’s leading provider of genomic-based diagnostic tests to help make more informed treatment decisions and reduce the overtreatment of early stage cancer, one of the greatest issues in healthcare today. The company is applying its world-class scientific and commercial expertise and infrastructure to lead the translation of massive amounts of genomic data into clinically-actionable results throughout the cancer patient’s journey, from screening and surveillance, to diagnosis, to treatment selection and monitoring.

2. Genomic Health’s breast cancer test, the Oncotype DX test, recently received a positive NICE recommendation for use in England and Wales.[1]

3. Genomic-based diagnostic tests have significant implications for improving outcomes for patients and reducing waste on unnecessary chemotherapy, including all its associated costs. A recent study in Wales^{^[2]} showed that just under a third of decisions on the treatment of breast cancer patients would be different with the extra insight provided by the Oncotype DX test. In the context of rising numbers of people living with cancer in the UK, we believe such personalised medicine will play a key role in enabling the NHS to manage its resources more efficiently.

4. Genomic Health has a UK subsidiary which is headquartered in London with its global head office in Redwood City, California.

5. Genomic Health welcomes the opportunity to respond to the Committee’s inquiry on access to medical technologies in Wales.

NICE assessment of medical technologies

6. The Oncotype DX test received a positive NICE recommendation for use in the NHS in England and Wales in September 2013, the diagnostics assessment process having commenced in March 2011. The evaluation process took more than two years, during which a lot of patients could have benefitted from the test.

Barriers to the adoption of new medical technologies

7. The NHS reforms have created considerable uncertainty around commissioning arrangements for new medical technologies. To date, our company has received a number of inquiries from clinicians regarding how to access the Oncotype DX test for their patients. We understand that Local Health Boards are required to approve requests for new services before these are referred to the Welsh Specialised Services Committee. However this means there will be further delays in access to the test while plans are scrutinised at local level.

8. The concern is that a number of other factors relating to pressures on NHS budgets, a culture of conservatism to emerging technologies and ageism in clinical decision-making may restrict the adoption of new medical technologies in Wales. This would effectively inhibit access to personalised medicine that could improve patient outcomes and reduce chemotherapy costs for the NHS.

Conclusion

9. A clear commissioning policy to enable breast cancer patients to access genomic-based diagnostic tests would give them their best chance for treatment success. The benefits of the Oncotype DX have been demonstrated through the rigours of the NICE process. It is important that patients across have fair and equitable access to such innovative medical technologies that have received NICE approval

10. We would be delighted to come and talk to the Committee about the matters raised in our evidence.