Tuesday, August 22, 2006


The Government's value- for-money watchdog is set to refuse approval for two new bowel cancer drugs, to the fury of patients and cancer charities. Nice, the National Institute for Health and Clinical Excellence (Nice), will recommend today that Avastin and Erbitux are not sufficiently good value to justify NHS prescription. Andrea Sutcliffe, deputy chief executive, said: "Although bevacizumab [Avastin] does show some increased benefit over standard treatment, the [Nice] Appraisal Committee was not persuaded that it was cost-effective in the treatment of metastatic colorectal cancer. "The evidence available on cetuximab [Erbitux] does not compare it to current standard treatment and we are not able to assess whether it is any better than existing treatments."

The judgment is not final and is open to appeal before guidance is issued in November. But cancer charities are preparing a challenge. They argue that the two drugs work, shrinking tumours and extending life in patients with advanced colon cancer, even if they are not a cure. They are widely available elsewhere, including across most of Europe. Hilary Whittaker, chief executive of Beating Bowel Cancer, said: "We urge Nice to reconsider. Why should patients in the UK be worse off than patients in the rest of Europe?" Michael Wickham, the chief executive of Bowel Cancer UK, said: "The NHS of 2006 is, it seems, content to fund a 10 billion pound overspend on information technology but not to give patients treatments that can help them live longer." Denise Richard, of Merck Pharmaceuticals, which makes Erbitux, said: "The UK is the only country in Europe where Erbitux has been licensed but is not routinely available to patients because the NHS will not fund it."

Bowel cancer is the third-commonest cancer in the UK, with 35,000 new cases every year and 16,000 deaths. More than half the patients will develop cancers that spread, for which the five-year survival rate is only 12 per cent. Avastin and Erbitux are new medicines that work by targeting a growth factor that stimulates the growth of blood vessels needed by tumours to grow. Both are licensed and in trials have shown effectiveness in tumours that are resistant to chemotherapy. Erbitux, used with the traditional drug irinotecan, shrank tumours by half in a quarter of patients and slowed progression of the disease by four months in half of patients. Avastin had similar effects on survival when used with other drugs.

However, the question that Nice has to answer is whether the drugs are cost-effective. Nice measures the cost per life-year saved, with a threshold of effectiveness of about 30,000 pounds. Neither passes this test: Avastin costs between 83,000 and 107,000 pounds, and Erbitux between 39,000 and 69,000. One patient who is taking Erbitux is David Taylor, 54, a journalist who lives in North London. He had colorectal cancer diagnosed in 2004. Treatment with conventional drugs began in January 2005. But the disease progressed and his consultant warned him: "We're running out of drugs."


Federal bias against sick men in Australia

Men are being denied free access to a cancer drug, even though it is available to female patients. Women fighting breast cancer can get the chemotherapy drug Taxotere (docetaxel) free on prescription under the Pharmaceutical Benefits Scheme. But men with prostate cancer who don't have private medical insurance have to pay almost $3000 for each treatment. Some patients need up to 20 treatments, making it impossibly expensive for many. Taxotere is the only chemotherapy drug proven to extend the lives of men with incurable prostate cancer.

Leading urologist Prof Tony Costello said 3000 men died every year from the disease in Australia. "A significant proportion would be candidates for the drug," he said. Tony Gianduzzo, Queensland chairman of the Urological Society of Australasia, agreed: "It would be nice to have it available for those men who would benefit."

They agreed men were victims of their failure to lobby as effectively as women did. "Men have been pretty poor advocates for their own cancer," Prof Costello said. "It's up to people like us who have to look after these folk to lobby for the drug to be made available on the PBS."

Taxotere was made available for breast cancer patients in 1997. Two years ago, it was discovered that it could also be used to treat men with malignant prostates - the biggest cause of cancer deaths in males. The treatment has been found to extend the lives of prostate patients by an average two months more than standard treatments, and up to two years in some cases. For breast cancer patients, the average increase was 2.2 months.

Federal Labor frontbencher Wayne Swan, who was successfully treated for prostate cancer five years ago, backed the push for the drug to be made freely available. "There is a strong case for the listing of this drug. I would give the doctors all the support I possibly could," said the Member for Lilley, on Brisbane's northside. "It certainly looks like there is a double standard in its use, and you can only assume the decision was financial, not medical."

A spokeswoman for Federal Health Minister Tony Abbott said an application by the manufacturers of Taxotere for it to be added to the PBS for prostate cancer treatment had been rejected. "It's up to them to try again," she said. "The Government doesn't go touting for drug companies to apply." The Federal Government spent $157 million in 2004-05 subsidising several breast cancer treatments.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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