Life-extending cancer drugs to be axed by NHS

http://www.theguardian.com/society/2015/sep/03/life-extending-cancer-drugs-to-be-axed-by-nhs

NHS England de-lists costly Kadcyla drug, among 16 others, in wake of ‘overspent’ Cancer Drugs Fund

New and costly cancer drugs developed to extend the lives of patients are expected to be axed on Friday from an NHS list. Among the drugs NHS England is expected to “de-list” from the Cancer Drugs Fund is Kadcyla, which holds the record as the most expensive cancer drug brought to market, costing £90,000 annually per patient.

Kadcyla, made by Roche, was rejected from general NHS use by the National Institute for Health and Care Excellence (Nice), the body that assesses new medicines for their cost-effectiveness.

Nice agreed the drug was effective for women whose advanced breast cancer no longer responded to Herceptin, but its chief executive, Sir Andrew Dillon, was outspoken about the “unacceptable” price tag. “We had hoped that Roche would have recognized the challenge the NHS faces in managing the adoption of expensive new treatments by reducing the cost of Kadcyla to the NHS,” Dillon said in April 2014.
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More than 400 women are able to take the drug, which can extend life by six months, because it is funded by the Cancer Drugs Fund, which was set up by the coalition government. The fund was a political response to the furore that broke out whenever Nice turned down a new cancer drug.

But the fund is now overspent. It was launched as a £200m-a-year fund in 2011, but by January this year it was on course to reach £380m a year. The government announced more money, which has brought it to £340m a year, but NHS England at the same time moved to shrink the list.

NHS England this March axed 16 drugs involved in 35 different cancer treatments (some drugs are used in more than one cancer), though at least one was reinstated after the manufacturer agreed to lower the cost.

Patients now using drugs that are de-listed will continue to get them, but new patients will not. According to Roche, 1,300 women a year could benefit from Kadcyla.

Breast cancer charities and the patients agree that Kadcyla (generic name, trastuzumab emtansine) is effective and the last hope for women with a certain type of advanced breast cancer. A second Roche breast cancer drug, Avastin, is also thought to be under threat, although it does not have the same life-extending efficacy as Kadcyla. Most of the drugs threatened with de-listing add only a few weeks of life for those with terminal cancers.
In May, a group of experts from the European Society for Medical Oncology said that many modern cancer drugs were of very little benefit to patients. They published a scoring system, unconnected with cost, which showed that many did not extend or improve people’s lives for very long.

Roche pre-empted criticism of its prices with a video on YouTube in which its medical director, Daniel Thurley, and director, Deborah Lancaster, said the fund had been hugely successful, enabling thousands of patients to get access to cancer drugs. Lancaster said the financial problems of the fund arose from the great demand for the drugs “because they are so effective”. The pair said they were still talking to NHS England.

NHS England has said that the fund will be replaced, but discussions over the mechanism to be put in its place continue. The fund has always been a political hot potato. Labour is expected to capitalise on the de-listing announcement and accuse the government of betraying cancer patients and backtracking on pledges to keep supporting the fund.

Labour will stress that the Tories’ general election manifesto stated: “We will continue to invest in our lifesaving Cancer Drugs Fund.” As recently as June, George Freeman, the life sciences minister at the Department of Health, told MPs that the government had “committed to continuing to invest in the fund”.

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