The Times (KC) 07-Aug-08
From Kidney Cancer Resource
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£35,000-a-year kidney cancer drugs too costly for NHS
Veto on basis of price is outrage to kidney patients, says specialist
By: Nigel Hawkes, Health Editor
Four new drugs to treat advanced kidney cancer have been rejected as too expensive for use by the NHS.
Although they can extend life by up to six months, they cost too much, the National Institute for Health and Clinical Excellence (NICE) says.
It has concluded that the money would be better spent elsewhere in the NHS, where it would do more good. The decision to issue draft guidance rejecting Sutent (sunitinib), Avastin (bevacizumab), Nexavar (sorafenib) and Torisel (temsirolimus) has outraged charities, kidney specialists and campaigners. It leaves patients with only one treatment option, interferon, to which many do not respond.
John Wagstaff, an honorary consultant in medical oncology at the South Wales Cancer Institute in Swansea and director of the Wales Cancer Trials Network, said there was “no point” in him accepting referrals for people with advanced kidney cancer because about 75 per cent of them “do not gain any real benefit” from interferon. The only other option, he said, was to make patients comfortable in their last months. Cancer Research UK expressed “deep concern” over the draft guidance. Professor Peter Johnson, its chief clinician, said: “These drugs have shown a small but definite improvement in an illness where there are few alternative treatments. 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. Action is needed to bring these two positions closer together.”
James Whale, the broadcaster, who lost a kidney to cancer in 2000, said that the guidance would “mean an early death sentence for many” if it were not revised.
The draft guidance issued today says that the drugs are not cost-effective for patients with advanced kidney cancer, or kidney cancer that has spread to other organs. Some patients are already being treated with the medicines and they should be allowed to continue to have them until they and their doctors consider it appropriate to stop, NICE says.
Up to 7,000 people in Britain develop kidney cancer every year. Of these, about 1,700 will have advanced kidney cancer and at any one time about 3,600 people are living with the advanced form of the disease.
Professor Peter Littlejohns, the clinical and public health director of NICE, said: “The decisions NICE has to make are some of the hardest in public life. NHS resources are not limitless and 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. [They] have the potential to extend progression-free survival by five to six months, but at a cost of £20,000 to £35,000 per patient per year.
“If these treatments were provided on the NHS, other patients would lose out on treatments that are both clinically and cost-effective.”
Professor Wagstaff said: “The possibility that we may be prevented from offering Sutent to our patients is an outrage and a devastating blow to the kidney cancer community. This will mean that the UK will have the poorest survival figures for metastatic renal cell cancer in Europe.
“Sutent produces a remarkable effect on survival for patients. It is now no longer ethical or reasonable for patients to have access to treatment only with interferon.”
Appeals against the draft guidance can be made until August 29. NICE will consider them at a meeting on September 10 before issuing final guidance. The Scottish equivalent of NICE, the Scottish Medicines Consortium, has also rejected Sutent for NHS prescription.
Budget for survival
- NICE sets a threshold of £30,000 per year of good-quality life (QALY) gained when it considers drugs for NHS use. Drugs that cost more than this are not normally approved
- According to Pfizer, which makes Sutent, its cost per QALY gained is within the threshold, at £28,546. But NICE’s calculations put the cost at £48,052
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