Doctors face quandary on who to treat

24 November 2006 18:33

Some patients are being denied treatments because of the high cost of delivering the revolutionary breast cancer drug Herceptin to other people, according to a group of Norwich-based researchers.

Doctors at the Norfolk and Norwich University Hospital and researchers at UEA found that to balance the books, providing the expensive drug might mean having to cut other effective treatments.

Hospitals in England and Wales have been told they should offer Herceptin to all suitable patients with early breast cancer. But the new guidance from the National Institute for Health and Clinical Excellence (Nice) presents a financial headache for those holding the NHS purse strings.

An illustration of what this may mean was outlined on Friday by cancer specialists at the N&N

Herceptin, which works for 20-25pc of breast cancer patients with a particular defective gene, costs around £20,000 per year.

Doctors Ann Barrett, Tom Roques and Matthew Small calculated that in drug costs alone, they would have to find £1.9 million to treat 75 eligible patients with Herceptin.

Adding the cost of testing, monitoring, pharmacy preparation and drug administration pushed the figure up to £2.3 million.

The team, working with health economist Richard Smith from UEA, said they could fund Herceptin if they dropped post-surgery cancer treatments for 355 other patients - 16 of whom were likely to be cured.

Alternatively, they could stop palliative chemotherapy for 208 patients. In either case it would also be necessary to find £500,000 from another source.

In Norfolk, there has been a progressive approach from primary care trusts, which agreed to fund provision of Herceptin to patients long before the Nice ruling and while some women in other parts of the country were fighting for the right to the drug in the High Court.

The Norfolk doctors wrote in the British Medical Journal: “These untreated patients will be people we know. We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the 'treatment of the moment'.

“The real cost of Herceptin is in the other patients not treated, whether they are patients with cancer or those with other conditions. Nice gives no guidance on this issue.”

However, Dr Rogues, who is a consultant clinical oncologist at the N&N, said the findings were general across the UK, rather than specific to the N&N.

“We are still giving all of our cancer patients the treatment we would like to give but at the same time budgets across Norfolk and the rest of country are being cut and it is getting more an more difficult to give all the treatments we would like,” he said, adding that other cancer drugs were also receiving Nice approval, but there was no extra funding to prescribe them.

Herceptin was given Nice approval only after court action by several patients whose cases were widely publicised.

The doctors said media bias, industry support and 'political gaming' put considerable pressure on the NHS to offer Herceptin to early stage patients.

Nice, which was supposed to be an independent body, appeared to have adopted a 'rubber-stamping' role, they argued.

“Nobody has suggested what treatments we cut in favour of Herceptin - not the media, medical advocates of the drug, the courts who upheld patient appeals, or Nice,” the doctors added.

“It would be especially interesting to know what the Secretary of State for Health would like us to cut. Political pressure, patient advocacy, and media hyperbole should not determine who is treated and what they are treated with.”

The doctors said Nice should be made responsible for deciding what services should be cut to fund new treatments, or given the power to allocate extra funds for their implementation.

Health Minister Rosie Winterton said: “Doctors treat patients according to their clinical need. It is quite wrong to say that Herceptin is the only drug that is likely to be funded.

“PCTs should always be planning ahead and we would expect them to consider the implications of introducing all drugs on the horizon, not just Herceptin.”

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