BBC (KC) 07-Aug-08

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Row over NHS kidney drug decision

KIDNEY Blood Supply

Patients with advanced kidney cancer will be denied four treatments on the NHS under proposals from the government's drugs advisory body.

The drugs - bevacizumab, sorafenib, sunitinib and temsirolimus - do not offer value for money, according to draft guidelines for England and Wales.

Some experts reacted angrily to the decision, saying it left them with little option for treating patients.

More than 7,000 people are diagnosed with kidney cancer annually in the UK.

Of these, around 1,700 patients will be diagnosed with advanced kidney cancer.

 If these treatments were provided on the NHS, other patients would lose out on treatments that are both clinically and cost effective 

Professor Peter Littlejohns, NICE

'We'd sell our house for this drug'

Although there are treatments available, none of them "cure" advanced renal cell carcinoma or cancer that has spread from the initial tumour.

But they can help extend a patients' life by around five to six months.

The drugs which also go by the names Avastin (bevacizumab), Nexavar (sorafenib), Sutent (sunitinib) and Torisel (temsirolimus) were found by the National Institute of Health and Clinical Excellence (NICE) to provide "significant gains" in survival.

However, further analysis showed they did not meet NICE criteria for "cost-effectiveness".

The NHS in Scotland has already advised against the use of three of the drugs, and an application has never been made for temsirolimus. A decision has yet to be taken in Northern Ireland.

The draft guidelines for England and Wales, which are subject to appeal, recommended people already on the drugs should be able to continue therapy.

Dr. Pat Hanlon says the treatment provides a 'considerable benefit'. Charities and some experts expressed outrage at the decision, saying it left patients only one treatment option - interferon - to which many do not respond.

Professor John Wagstaff, from the South Wales Cancer Institute, said there was "no point" in him accepting referrals for people with advanced kidney cancer as around 75% of them "do not gain any real benefit" from interferon.

The only other option was to make patients comfortable in their last months of life.

Professor Peter Johnson, from Cancer Research UK, said the drugs had shown a small but definite improvement in an illness where there are few alternative treatments.

HAVE YOUR SAY These drugs are available to patients in Europe. Why should people in the UK be denied them? Joanna, Twickenham Send us your comments"This decision once again raises questions about whether NICE's system of appraisal is appropriate for all types of drugs.

"Although we understand that NICE often has to make difficult decisions, in this case there is a clear separation between what NICE finds to be valuable treatment, and clinical and patient opinion."

But Professor Peter Littlejohns, clinical and public health director at NICE, said NHS resources were "not limitless" and hard choices had to be made.

COST TO THE NHS 

The drugs cost between £20,000 to £35,000 a year per patient That equates to between £71,500 to £171,300 for every year of healthy life gained

"NICE has to decide what treatments represent best value to the patient as well as the NHS.

"Although these treatments are clinically effective, regrettably, the cost to the NHS is such that they are not a cost-effective use of NHS resources."

He said they would consider proposals from manufacturers to reduce the cost of the drugs once it had been approved by the Department of Health.

"If these treatments were provided on the NHS, other patients would lose out on treatments that are both clinically and cost effective," he added.

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