Other patients bear the real cost of Herceptin

How much will Herceptin really cost? BMJ Volume 333 pp 1118-20

The real cost of Herceptin is borne by other patients whose treatment has to be dropped to balance the books, say doctors in this week’s BMJ.

New guidance from the National Institute for health and Clinical Excellence (NICE) recommends trastuzumab (Herceptin) 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.

Doctors at the Norfolk and Norwich University Hospital NHS Trust and the University of East Anglia calculated that they will have to find £1.9m each year to make Herceptin available to the patients who may be eligible. This becomes £2.3m if the costs of testing and monitoring patients are added.

But the real cost lies in the services that will be cut to provide this money, they write.

To illustrate this, they audited drug costs in their hospital’s cancer centre and estimated how they could save £1.9m by cutting chemotherapy and palliative care treatments.

The sum of £1.9m would enable us to treat 75 patients with Herceptin, but at four times the cost of the adjuvant treatments, they say. These treatments have been proved to be clinically effective and their estimated cost effectiveness is far greater than that currently expected for Herceptin.

So they could fund 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 £500,000 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.”

These results are obviously not definitive, but illustrate the fundamental challenge facing the NHS – the tension between national priority setting and local implementation, they add.

This situation highlights our central argument, that as NICE guidance provides no extra funding or any suggestion of which services to cut, medical professionals ultimately have to make these decisions.

Political pressure, patient advocacy and media hyperbole should not be the determinant of who is treated and with what, they argue. In NICE we have an established system, but it is currently creating more problems than solutions.

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.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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