High Herceptin costs leave patients untreated, say UK doctors

In the British Medical Journal, the doctors say that new guidance from the National Institute for Health and Clinical Excellence (NICE) recommends trastuzumab (marketed as Herceptin by Genentech) in early breast cancer, but it provides no extra funding and does not suggest what cuts should be made to release this extra money. This leaves medical staff with difficult decisions to make, they add.

Doctors at the Norfolk and Norwich University Hospital NHS Trust and the University of East Anglia calculated that they will have to find GBP1.9 million each year to make Herceptin available to the patients who may be eligible. This becomes GBP2.3 million if the costs of testing and monitoring patients are added.

However, the doctors calculated that hospitals can only afford Herceptin if they did not treat 355 patients receiving adjuvant treatment (16 of whom would be cured) or 208 patients receiving palliative chemotherapy, and if they found GBP500,000 from another source.

“These untreated patients will be people we know,” say the authors. “We will be the ones to tell them they are not getting treatment that has been proved to be effective and which costs relatively little, because it is not the treatment of the moment.”

They believe that NICE should be given responsibility to decide what should be cut to fund newly recommended technologies or the ability to allocate extra funds for implementation, or both.