The Guardian (KC) 25-Aug-08

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Specialists question decision not to fund drugs for kidney cancer

  • Advisory body says treatment too expensive
  • Doctors say Nice has got its sums wrong

The government's drug advisory body has defended its methods of assessing what cancer treatments should be offered to patients after some of the country's most eminent cancer specialists told it to "get its sums right".

The National Institute for Health and Clinical Excellence (Nice) issued a statement at the weekend explaining its methodology after 26 oncologists - including the directors of oncology at two of Britain's biggest cancer hospitals - wrote to the Sunday Times and called for "radical change" in the way Nice makes its decisions.

The oncologists were reacting to a decision by Nice this month not to give the go-ahead to four drugs that slow the progress of kidney cancer but do not cure it. The oncologists said Nice assessed cancer treatment "poorly" and its economic formulas were "not suitable", with often traumatic effects.

The letter said: "We have seen distraught patients remortgaging their houses, giving up pensions and selling their cars to buy drugs that are freely available to those using health services in countries of comparable wealth."

The specialists challenged Nice to explain what they saw as a discrepancy between the UK and European countries that spend as much on healthcare but, on average, a third more on cancer drugs.

Reacting to the oncologists' attack, the chief executive of Nice, Andrew Dillon, said the oncologists were wrong and questioned the research their argument was based on. He said that in the last nine years Nice had appraised 56 anti-cancer drugs and given the go-ahead to 52.

Nice said this month that it would not approve four drugs, Sutent, Avastin, Nexavar and Torisel, which help to delay the progress of renal cancer (pictured) by up to six months. Advanced renal cancer is diagnosed in around 3,600 people a year. Nice makes such decisions by measuring what it calls quality-adjusted life years (Qalys) - the cost of securing an extra year of healthy life by providing new medicine. Nice's clinical director, Professor Peter Littlejohns, ruled that the cost of the four drugs was, in terms of Qalys, six times too high. The normal NHS limit is about £30,000 a patient per quality-adjusted year.

In his letter to the oncologists, Dillon underscored what he thought to be the impartial nature of Nice's appraisal committee. He said: "The provisional conclusions on the use of drugs for treating renal cancer are those of an independent appraisal committee whose membership is largely drawn from NHS clinicians in active practice. They understand the issues at stake; they themselves are often involved with the care of patients with cancer; but they are also involved in the day-to-day care of patients with other conditions, many as distressing."

Dillon challenged the cancer specialists to decide which other treatments should be sacrificed. He said: "To maintain the credibility of their argument, they need to explain which patients - with other diseases - should forgo cost effective care in order to meet the needs of those with renal cancer.

"There is a finite pot of money for the NHS. If one group of patients is provided with cost ineffective care, other groups - lacking powerful lobbyists - will be denied cost effective care for miserable conditions like schizophrenia, Crohn's disease or cystic fibrosis."

Kevin Barron, a Labour MP who chairs the Commons health select committee, defended Nice, saying the NHS was not a "bottomless pit" and someone had to make difficult decisions about the cost of drugs. He said: "Nice is doing it better than what we had 10 years ago which was clinicians making the decisions."

He added that Nice even appeared to be forcing some pharmaceutical companies to look at their prices. "Two out of the five big pharmaceutical companies are allegedly looking into their pricing and if they are prepared to go back and look at the cost of their drugs - to make them more cost effective - then I welcome that."

This week patients from the Kidney Cancer Support Network will stage a protest outside the London offices of Nice.

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