April 29, 2014
Cancer Treatment: The Price Of Life
It may be one of the hardest things anyone has to do, to calculate what price you are willing to pay to keep someone alive. While I am not normally one to feel sympathy for government agencies, in this case I do not envy the decision makers at the UK’s National Institute for Clinical Excellence (NICE) one little bit. NICE is an organization whose remit includes evaluating new drugs for the National Health Service, both for safety and for cost effectiveness. They are in the firing line at the moment, not for the first or last time, as they have just turned down a new treatment for advanced breast cancer; not because it was dangerous or ineffective, but simply on the grounds that it is too expensive. Predictably, the whole thing has turned into a blame game with NICE claiming that the manufacturer Roche is asking too much while Roche will defend its pricing on the basis of the huge costs of research and production. The heart-breaking thing, of course, is that while the arguments rage, women who might have benefited from the drug can only watch from the sidelines.
So what price do you put on a life? In this case, Roche is demanding £90,000 (around US$145,000) for a course of treatment with the drug in question – trastuzumab emtansine or “Kadcyla.” That’s a lot of money, especially as Kadcyla is not a cure, but a drug that will hopefully extend life expectancy for women with certain types of advanced breast cancer for up to six months. It may be a lot of money, but six months is a lot of life if that’s all you have. This is a life and death decision-making process that has to come down to mathematical equations. To see the benefits of what is believed to be Kadcyla treatment, please read this Guardian article.
Kadcyla is targeted at a specific form of breast cancer known as HER2+, which is inoperable. The drug is a combination of the widely used Herceptin treatment coupled with a chemotherapy agent. Some HER2+ sufferers are currently receiving Kadcyla treatment funded by the government’s own dedicated Cancer Drugs Fund, which decided to provide the therapy during NICE’s consultation period without waiting for the decision. But that decision means it will not now be available through normal NHS channels. It also looks like this Cancer Drugs Fund support will now come under threat, but one can only hope and expect that those already receiving Kadcyla will see their treatment regime continued.
Cancer charities have criticized the NHS for turning down Kadcyla and other expensive treatments. The NHS has asked Roche to reconsider its pricing and have pointed out that the high cost of this and similar drugs would divert resources away from other areas of the organization.
The case against the NICE decision rests mainly on the fact that, although Kadcyla costs much more than current treatments, it extends life expectancy more than other drugs and it represents a major advance in that the side effects are much less devastating. It therefore provides patients with a much better quality of life, as well as those invaluable extra months.
The NHS is already struggling against deficits and lack of funding, so there is no bottomless pit full of money. Something has to give, but I for one would not want to face the moral and pragmatic dilemmas that this decision raises. Perhaps a large part of any answer would come from a consideration of how the major drug companies price and supply their products, as well as the massive profits they make, but that’s another article.
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