Drug for Scots only?

Nutty British health bureaucrats disagree with one-another -- too bad for patients in England

A cancer drug has been approved for prescription in Scotland that is unlikely to be obtainable for patients who live south of the Border. The Scottish Medicines Consortium (SMC) said that Sprycel was cost-effective for use in the chronic phase of myeloid leukaemia, providing a lifeline for patients who have developed resistance to the “wonder-drug” Glivec. But the National Institute for Health and Clinical Excellence (NICE), which performs the same value-for-money assessment for England and Wales, does not have Sprycel on its list of forthcoming appraisals.

That is likely to mean that English and Welsh patients will find it difficult to get the drug on the NHS. Technically, doctors can prescribe any drug that is licensed, as Sprycel is, but in practice, primary care trusts are reluctant to pay for any that lack the imprimatur of NICE. In recent months the Scottish consortium has proved more ready to approve cancer drugs than NICE. Among these are Alimta for mesothelioma, Erbitux for head and neck cancers, Tarceva for lung cancer and Velcade for myeloma in patients who have failed on at least two prior therapies.

Sprycel, from Bristol-Myers Squibb, inhibits the growth of leukaemia cells, enabling adults with some types of leukaemia to control the disease over a sustained period. It is the first option for patients with chronic myeloid leukaemia who have developed resistance to Glivec, the drug that transformed treatment of the disease. After some time, a proportion of patients find that Glivec can no longer control the disease. Sprycel gives these patients an option. It is also useful in treating patients with some types of acute lymphoblastic leukaemia. Introduced last December, it has been reviewed by SMC, and declared cost-effective.

The number of patients who could benefit potentially is small, perhaps no more than a few hundred a year. That may enable primary care trusts to take a more lenient view, especially as patients will already have been on Glivec and Sprycel is costed at about the same price.

Tessa Holyoake, honorary consultant haematologist at Glasgow Royal Infirmary, said: “Today’s announcement is an important step forward in the management of chronic myeloid leukaemia (CML). “Dasatinib [Sprycel] offers a new option for patients in the chronic phase of the disease who have developed resistance or intolerance to prior treatment including imatinib [Glivec], who previously had a very poor prognosis due to the lack of effective alternatives.” Tony Gavin, of Leukaemia CARE, said: “We are keen to see equal and fair access to treatment for patients throughout the UK. While the SMC decision is obviously great news for Scottish CML patients, we are very concerned that patients living in other parts of the UK may be denied access because of funding constraints.”

Welcoming the announcement, Frank Pasqualone, managing director of Bristol-Myers Squibb Pharmaceuticals, said: “We are delighted with the SMC’s decision and hope that CML patients in the chronic phase with resistance or intolerance to imatinib have been given renewed optimism in their fight against this rare but life-threatening disease. “Recommendations such as this make medicines more accessible to the patients who need them. Sprycel builds on our company’s long legacy of providing innovative oncology medicines to patients.”

CML, although relatively rare, is a devastating condition that accounts for about 15 per cent of all leukaemias. About 2,600 people are currently affected by it in the whole of Britain. In Scotland, about 60 new cases are diagnosed each year.

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Australia: State government hospitals cannot accomodate difficult twin birth



A PREGNANT mother has been shunted between three hospitals up to 200km from her Sydney home because doctors can't find enough neo-natal beds for her premature twins. NSW Health was last night desperately searching for two specialised cots – which cost $1 million each – in Sydney to house April Mackey ahead of the impending arrival of her twins. The mother-of-three is 29 weeks pregnant and has spent the past two days at John Hunter Hospital, in Newcastle, despite living at Badgery's Creek in western Sydney. Doctors have been unable to find two neo-natal intensive beds at a Sydney hospital, despite 124 being in use across the state.

Mrs Mackey told The Daily Telegraph last night she was not sure if she could have her babies, due any day, at the hospital, which did have two available neo-natal cots. "They are telling me the beds are no longer available so I have no idea where I will be sent to next," Mrs Mackey said. "This is supposed to be a joyous occasion and yet I am stressed out worrying about where I am going to be. I've got no one here with me because all of my family is in Sydney."

Mrs Mackey, 32, went into labour last week when the water around one of her twins broke. When she visited Nepean Hospital she was told there were no beds and she was sent to Royal Women's Hospital at Randwick. From there she was transported by ambulance to Newcastle but during the journey she was transferred from one ambulance to another. Her husband Colin has had to remain in Sydney to care for their three other children. "I just want to get back to Sydney to be there for my children," she said.

Health Minister Reba Meagher said it was impossible to have the intensive care cots at every hospital. "It is not possible to have these very intensive cots at every hospital because of the cost and the care involved," she said. "There has been some communication breakdown with the family. I've asked NSW Health to address that promptly and I've asked appropriate accommodation be found for her and her family." Opposition health spokeswoman Jillian Skinner said it was a sad indictment on the health system.

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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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